拔管前腹内压变化值对机械通气患者拔管失败的预测价值

Predictive value of the changes in intra-abdominal pressure before extubation for the extubation failure in mechanically ventilated patients

目的探讨拔管前腹内压变化值(ΔIAP)对机械通气患者拔管失败的预测价值。方法选取2018年12月至2021年2月入住常熟市第一人民医院重症医学科通过自主呼吸试验(SBT)且机械通气>24 h的患者188例。在拔除气管插管前30 min,通过导尿管与静脉连接管相连进行手工液柱测量由气道吸引诱导咳嗽而产生的ΔIAP。收集患者的拔管结局、疾病资料和预后情况。根据拔管结局分为拔管成功组(n=160)和拔管失败组(n=28)两组,比较两组患者的ΔIAP,并运用受试者工作特征(ROC)曲线来分析ΔIAP对拔管失败的预测价值。结果拔管失败组的ΔIAP低于拔管成功组(中位数30 cm H_(2)O vs.43 cm H_(2)O,P=0.000)。通过ROC曲线分析ΔIAP对拔管失败预测的曲线下面积(AUC)为0.709,临界值为40.5 cm H_(2)O(敏感度82.1%,特异度53.1%)。通过单因素分析得出ΔIAP≤40.5 cm H_(2)O、体重指数(BMI)、机械通气时间、ICU住院时间是拔管失败的影响因素,纳入Logistic回归多因素分析后,显示ΔIAP≤40.5 cm H_(2)O是影响拔管失败的独立预测因子(OR 3.926,95%CI 1.301~11.852)。结论拔管前ΔIAP对机械通气患者的拔管失败具有较好的预测价值,当ΔIAP≤40.5 cm H_(2)O时,患者拔管失败的风险更大。

Objective To explore the predictive value of the changes in intra-abdominal pressure(ΔIAP)before extubation for the extubation failure in mechanically ventilated patients.Methods188 patients with mechanical ventilation for more than 24 h who passed the spontaneous breathing test(SBT)and were recruited to the intensive care unit of Changshu No.1 People’s Hospital from December2018 to February 2020 were selected.Thirty minutes before the extubation,a manual liquid column was used to measure theΔIAP caused by coughing induced by airway suction through a urinary catheter connected to the venous connecting tube.The researcher collected the patient’s extubation outcome,disease data and prognosis.According to the extubation outcome,the patients were divided into two groups:extubation success group(n=160)and extubation failure group(n=28).TheΔIAP levels of the patients in the two groups were compared,and the receiver operator characteristic curve(ROC)was used to analyze the predictive value ofΔIAP for extubation failure.Results TheΔIAP of the extubation failure group was lower than that of the extubation success group(median 30 cm H_(2)O vs.43 cm H_(2)O,P=0.000).The area under the curve(AUC)predicted by ROC curve analysis ofΔIAP for extubation failure was 0.709,and its cutoff value was 40.5 cm H_(2)O(sensitivity 82.1%,specificity 53.1%).The univariate analysis showed thatΔIAP≤40.5 cm H_(2)O,body mass index(BMI),mechanical ventilation time,the length of ICU stay were the influencing factors for extubation failure.The Logistic regression analysis showed thatΔIAP≤40.5 cm H_(2)O was an independent predictor of extubation failure(OR3.926,95%CI 1.301-11.852).Conclusions TheΔIAP before extubation has a good predictability for extubation failure in mechanically ventilated patients.WhenΔIAP≤40.5 cm H_(2)O,the risk of extubation failure in the patients is greater.