SOFA评分结合NT-proBNP在肺部感染呼吸衰竭患者机械通气撤机中的应用

SOFA score combined with NT-probNP in the application of mechanical ventilation and withdrawal in patients with pulmonary infection and respiratory failure

目的探讨SOFA评分结合NT-proBNP在肺部感染呼吸衰竭患者机械通气撤机中的应用。方法选取2017年3月至2019年4月本院收治的60例行机械通气的肺部感染呼吸衰竭患者,依据48 h内撤机结果,分为撤机失败组(n=14)和撤机成功组(n=46)。分析患者一般资料、撤机前后NT-proBNP及临床指标、计划撤机前24 h内不同SOFA评分患者临床状况。结果撤机成功组与撤机失败组临床资料比较差异无统计学意义;入院时,两组NT-proBNP指标比较差异无统计学意义,撤机后,撤机成功组NT-proBNP指标高于撤机失败组(P<0.05),撤机前后48 h液体平衡量比较,撤机失败组呈正平衡,撤机成功组呈负平衡,撤机成功组BR指标低于撤机失败组(P<0.05);SOFA评分越高,呼吸机相关性肺炎、重症肺炎死亡率越高,撤机成功率越低。结论NT-proBNP可有效反映患者撤机前后容量状态及心脏功能的改变。SOFA评分与肺部感染呼吸衰竭具有明显相关性,减少肺部感染呼吸衰竭高危因素,对原发病及并发症积极治疗,合理应用抗生素,采取保护脏器功能的综合治疗措施,降低SOFA评分,可提高撤机成功率,改善患者预后。除了对肺部感染呼吸衰竭患者进行规范的撤机流程外,应用SOFA评分结合NTproBNP监测,可以进一步评估撤机前患者的病理生理状态,可作为撤机筛查试验的重要补充,优化撤机流程。

Objective To explore the application of SOFA score combined with NT-proBNP in mechanical ventilation and withdrawal for patients with pulmonary infection and respiratory failure.Methods 60 patients with pulmonary infection and respiratory failure admitted to our hospital from March 2017 to April 2019 were selected.According to the results of evacuation within 48 hours,the patients were divided into the failure group(n=14)and the success group(n=46).The general data of the patients,NT-proBNP and clinical indicators before and after the withdrawal,and the clinical status of the patients with different SOFA scores within 24 hours before the planned withdrawal were analyzed.Results There was no significant difference in clinical data between the successful group and the failure group.On admission,there was no statistically significant difference in NT-proBNP index between the two groups.After the withdrawal,NT-proBNP index of the successful withdrawal group was higher than that of the failed withdrawal group(P<0.05).After the withdrawal,the fluid balance of the successful withdrawal group was compared 48 h before and after the withdrawal,positive balance was found in the failed withdrawal group,negative balance was found in the successful withdrawal group,and BR index of the successful withdrawal group was lower than that of the failed withdrawal group(P<0.05).The higher the SOFA score,the higher the death rate of ventilator-associated pneumonia and severe pneumonia,and the lower the success rate of evacuation.Conclusion NT-proBNP can effectively reflect the changes of capacity state and cardiac function before and after withdrawal.SOFA scores has a significant correlation with pulmonary infection and respiratory failure.Reducing the risk factors of pulmonary infection and respiratory failure,actively treating the primary disease and complications,rationally applying antibiotics,adopting comprehensive treatment measures to protect organ function,and reducing SOFA scores can improve the success rate of withdrawal and improve the prognosis of patients.In addition to standard evacuation procedures for patients with pulmonary infection and respiratory failure,SOFA scores combined with NT-proBNP monitoring can be used to further evaluate the pathophysiological status of patients before evacuation,which can be used as an important supplement to screening test for evacuation and optimize evacuation procedures.