自主呼吸试验前后N端脑钠肽前体差值对非心源性危重症机械通气患者撤机结局的预测价值分析

Analysis of the predictive value of n-terminal brain natriuretic peptide precursors difference before and after spontaneous breathing test in patients with non-cardiogenic critical mechanical ventilation after withdrawal

目的:探讨对非心源性危重症行机械通气治疗的患者自主呼吸试验前后的N端脑钠肽前体(NT-proBNP)差值对预测患者撤机结局的价值。方法:选取重症监护室(ICU)病房2019年1月~2020年5月98例非心源性危重症患者为研究对象,患者均接受机械通气治疗,依据患者撤机结局将撤机成功的49例患者纳入试验组,撤机失败的49例患者纳入对照组,比较两组自主呼吸试验前后的外周血NT-proBNP水平,同时采取ROC曲线评价自主呼吸试验前后NT-proBNP差异对患者撤机结局的预测价值。结果:两组患者在治疗后外周血NT-proBNP指标水平均较治疗前提高,但试验组提高差值明显要比对照组低,差异有统计学意义(P<0.05);ROC曲线分析自主呼吸试验前后NT-proBNP预测患者撤机结局的敏度为90.9%,特异度为87.8%,对应NT-proBNP为581.5pg/ml。结论:对非心源性危重症的患者,观察自主呼吸试验前后NT-proBNP的差值对机械通气患者的撤机结局有良好的预测价值,值得推广。

Objective To investigate the value of the difference value of NT-probNP before and after spontaneous breathing test in predicting the outcome of patients with non-cardiogenic critical diseases treated with mechanical ventilation.Method Our hospital intensive care unit(ICU)ward in January 2019 to May 2020 treated 98 cases of non cardiac critically ill patients as the research object,the patients were treated with mechanical ventilation,based on the outcomes from machine will withdraw machine successful 49 patients into the experimental group,withdraw machine failure of 49 patients in control group,compared two groups of spontaneous breathing trial of peripheral blood before and after the NT-proBNP level,at the same time take the ROC curve evaluation of spontaneous breathing trial NT-proBNP differences of patients before and after the withdraw machine end of predictive value.Results The level of NT-probNP in peripheral blood of patients in both groups after treatment was higher than that before treatment,but the difference between the experimental group and the control group was significantly lower(P<0.05).ROC curve analysis showed that the sensitivity and specificity of NT-probNP before and after spontaneous breathing test were 90.9%and 87.8%respectively,corresponding to 581.5 pg/ml of NT-probNP.Conclusion For non-cardiogenic critically ill patients,the difference value of NT-probNP before and after the spontaneous breathing test has a good predictive value for the outcome of mechanical ventilation patients withdrawing from the machine,which is worth promoting.