N端脑钠素前体联合自主呼吸试验对机械通气撤机结局预测价值

Predictive value of combination of plasma N-terminal-pro-brainnatriuretic peptide and spontaneous breathing test for weaning from mechanical ventilation

目的探讨N端脑钠素前体(NT-proBNP)水平联合自主呼吸试验(SBT)对机械通气患者撤机结局的预测价值。方法回顾性分析自2009年1月至2010年12月于首都医科大学附属北京朝阳医院呼吸科重症监护病房内行机械通气的100例患者的临床资料。收集并比较所有患者的一般临床资料,包括年龄、性别、NT-proBNP值、SBT试验结果、撤机结局、失败原因等。根据48 h内的撤机结局将患者分为撤机成功组(n=68)与撤机失败组(n=32),比较两组的NT-proBNP水平。使用受试者工作特征曲线分析预测撤机结局的最佳NT-proBNP值,并探讨将这一最佳NT-proBNP值联合SBT试验结果对机械通气患者撤机结局的预测价值。结果撤机成功组NT-proBNP水平明显低于撤机失败组,差异有统计学意义(P<0.05)。NT-proBNP预测机械通气患者撤机失败的截断值为873.35 ng/L,在此截断值下的灵敏度为87.50%,特异度为80.88%。NT-proBNP≤873.35 ng/L患者(n=59)的脱机成功率为91.5%(54/59),高于NT-proBNP>873.35 ng/L患者(n=41)的34.1%(14/41),差异有统计学意义(P<0.05)。NT-proBNP≤873.35 ng/L同时通过SBT试验患者的撤机成功率为100.0%(47/47),明显高于单纯NT-proBNP≤873.35 ng/L患者的91.5%(54/59)及单纯通过SBT试验患者的80.3%(61/76),差异有统计学意义(P<0.05)。NT-proBNP≤873.35 ng/L且通过SBT试验是撤机成功的独立预测因素(P<0.05)。结论联合NT-proBNP水平与SBT试验结果来预测撤机成功率优于单独应用NT-proBNP或SBT试验预测。对各种原因所致呼吸衰竭机械通气患者,改善心功能对于顺利撤机均有十分重要的意义。

Objective To investigate the predictive value of N-terminal-pro-brain natriuretic peptide(NT-proBNP)level combined with spontaneous breathing test(SBT)in patients with mechanical ventilation.Methods A retrospective analysis was performed on the clinical data of 100 patients who received mechanical ventilation in the respiratory intensive care unit of Beijing Chaoyang Hospital,Capital Medical University from January 2009 to December 2010.General clinical data of all patients were collected and compared,including age,gender,NT-proBNP value,SBT test results,discontinuation outcome,failure causes,etc.Patients were divided into successful weaning group(n=68)and failed weaning group(n=32)according to weaning outcome within 48 hours.The levels of NT-proBNP in the two groups were compared.The best NT-proBNP value for predicting the outcome of discontinuation was analyzed by using the subject operating characteristic curve,and the predictive value of combining the best NT-proBNP value with SBT test results for the outcome of discontinuation of mechanical ventilation patients was discussed.Results The level of NT-proBNP in the successful weaning group was significantly lower than that in the failed weaning group,with statistical significance(P<0.05).The cut-off value of NT-proBNP for predicting discontinuation failure of mechanical ventilation patients was 873.35 ng/L,and the sensitivity and specificity were 87.50%and 80.88%under this cut-off value.The weaning success rate of patients with NT-proBNP≤873.35 ng/L was 91.5%(54/59),which was higher than 34.1%(14/41)of patients with NT-proBNP>873.35 ng/L.The weaning success rate of patients with NT-proBNP≤873.35 ng/L and passing SBT test was 100.0%(47/47),which was significantly higher than 91.5%(54/59)of patients with pure NT-proBNP≤873.35 ng/L and 80.3%(61/76)of patients with pure SBT test,the difference was statistically significant(P<0.05).NT-proBNP≤873.35 ng/L and passing the SBT test were independent predictors of the success of decompression(P<0.05).Conclusion Combining NT-proBNP level and SBT test results to predict the success rate of disconnection is better than using NT-proBNP or SBT alone.For mechanical ventilation patients with respiratory failure due to various reasons,improving cardiac function is of great significance for successful withdrawal.