肺部超声B线积分对机械通气患者脱机结果的预测价值

Predictive Value of Lung Ultrasound B-line Score on Weaning Outcomes in Mechanically Ventilated Patients.

目的探讨肺部超声B线积分(lung ultrasound B-line score,LUBS)对有创机械通气患者(invasive mechanical ventilation,IMV)脱机结果的预测价值。方法选取连云港市第一人民医院急诊重症监护室(EICU)收治的IMV患者60例,符合脱机标准的患者用T管进行自主呼吸试验(spontaneous breathing trial,SBT)。根据SBT成功与否分为SBT成功组与SBT失败组,分别测定两组LUBS,用受试者工作特征曲线(receiver operating characteristic curve,ROC)评价SBT前LUBS对SBT失败的预测价值;SBT成功组给予拔管,根据拔管是否成功(拔管成功定义为拔管后48h内无需再插管进行有创通气)分为脱机成功组和脱机失败组,对两组进行亚组分析,测定LUBS,用受试者工作特征曲线(ROC)评价脱机前LUBS对脱机失败的预测价值。结果共纳入60例IMV患者进行研究分析,其中SBT成功34例,失败26例。SBT成功组患者进行脱机拔管,其中脱机成功23例,脱机失败11例。SBT失败组LUBS明显高于SBT成功组,差异有统计学意义(P<0.05)。由ROC曲线可知,LUBS评分预测SBT失败的曲线下面积为0.858(95%CI:0.765-0.951),最佳阈值为12.5分时,敏感度为84.6%,特异性为73.5%,阳性预测值为70.9%,阴性预测值为86.2%。脱机失败组LUBS明显高于脱机成功组,差异有统计学意义(P<0.05)。由ROC曲线可知,LUBS预测脱机失败的曲线下面积为0.769(95%CI:0.576-0.962),最佳阈值为19.5分时,对应敏感度为54.5%,特异性为95.7%,阳性预测值为80.0%,阴性预测值为75.8%。结论肺部超声B线积分可以预测机械通气患者的脱机结果。

Objective To evaluate the predictive value of pulmonary ultrasound B-line integral(LUBS)on weaning outcomes in invasive mechanically ventilated patients(IMV).Methods A total of 60 IMV patients admitted to EICU of Lianyungang First People′s Hospital were selected.The patients who met the weaning standard were tested with T tube for spontaneous respiration(SBT).They were divided into SBT success group and SBT failure group according to whether passed SBT or not.The LUBS and hemoglobin concentrations of the two groups were measured respectively.The predictive value of LUBS to SBT failure before SBT was measured by the receiver operating characteristic curve(ROC).SBT successful group was given offline tube drawing.According to the tube drawing success(tube drawing successful defined as within 48h after extubation invasive ventilation without reintubation),they were divided into tube drawing success group and weaning failure group.subgroup analysis of ultrasonic B line score was performed,with the receiver operating characteristic curve(ROC)evaluation offline before LUBS predictive value of weaning failure.Results A total of 60 cases of IMV patients were included in the study,including 34 cases of SBT success and 26 cases of failure.Patients in the SBT successful group underwent weaning extubation,including 23 cases of successful weaning and 11 cases of failed weaning.LUBS in the SBT failure group was significantly higher than that in the SBT success group,with statistically significant difference(P<0.05).According to ROC curve,the area under the curve predicted by LUBS score for SBT failure was 0.858(0.765-0.951),the threshold was 12.5 points,the sensitivity was 84.6%,and the specificity was 73.5%,the positive predictive value was 70.9%,the negative predictive value was 86.2%.LUBS in the failed weaning group was significantly higher than that in the successful weaning group,with statistically significant difference(P<0.05).According to ROC curve,LUBS predicted the area under the curve of weaning failure was 0.769(0.576-0.962),the threshold was 19.5 points,the corresponding sensitivity was 54.5%,and the specificity was 95.7%,the positive predictive value was 80.0%,the negative predictive value was 75.8%.Conclusion Lung ultrasound B-line score can predict weaning outcomes in invasive mechanically ventilated patients(IMV).