CRP联合RSBI对COPD急性加重期并呼吸衰竭机械通气撤机的指导价值分析

Guidance value of C-reactive protein combined with rapid shallow breathing index in weaning patients with acute exacerbation of chronic obstructive pulmonary disease and respiratory failure

目的探讨C反应蛋白(CRP)联合浅快呼吸指数(RSBI)对慢性阻塞性肺疾病急性加重期(AECOPD)并呼吸衰竭机械通气撤机的指导价值。方法本研究为队列研究。采用整体抽样法, 选取2017年2月至2019年11月雅安市人民医院收治的146例AECOPD并呼吸衰竭且行机械通气治疗患者。统计撤机失败发生情况。根据是否撤机成功分为撤机成功组和撤机失败组。对比2组撤机前即刻CRP和RSBI水平。制作受试者工作特征曲线, 分析CRP联合RSBI对AECOPD并呼吸衰竭机械通气撤机失败的预测价值。结果 146例AECOPD并呼吸衰竭患者中撤机失败共42例, 发生率为28.77%。单因素分析显示, 2组的多脏器功能衰竭、年龄、CRP和RSBI水平差异均有统计学意义(χ^(2)=4.38, t=2.21, t=11.98, t=9.78, P值均<0.05)。Logistic回归分析结果显示, 年龄>60岁(OR=1.732, 95%CI:1.042~2.386)、CRP>10 mg/L(OR=1.863, 95%CI:1.131~3.101)和RSBI>105次·min^(-1)·L^(-1)(OR=2.152, 95%CI:1.021~3.661)是呼吸机撤机失败的影响因素。受试者工作特征曲线分析显示, CRP、RSBI对AECOPD并呼吸衰竭机械通气患者预测撤机失败的最佳截断值分别为12.18 mg/L、78.96次·min^(-1)·L^(-1);CRP联合RSBI对AECOPD并呼吸衰竭机械通气撤机失败预测的敏感度及特异度分别为78.57%和97.12%, 特异度高于CRP、RSBI单独评估;CRP联合RSBI对AECOPD并呼吸衰竭机械通气撤机失败预测的曲线下面积为0.926, 高于CRP和RSBI单独进行评估的曲线下面积(P<0.05)。结论 CRP、RSBI对AECOPD并呼吸衰竭机械通气撤机失败预测的评估效能较高, 二者联合可对AECOPD并呼吸衰竭机械通气患者的撤机失败进行预测。

Objective To investigate the guiding value of C-reactive protein(CRP)combined with rapid shallow breathing index(RSBI)in weaning mechanical ventilation in patients with acute exacerbation of chronic obstructive pulmonary disease(AECOPD)with respiratory failure.Methods This was a cohort study.Using the whole sampling method,a total of 146 patients with AECOPD and respiratory failure treated with mechanical ventilation in Ya′an People′s Hospital from February 2017 to November 2019 were selected.The failure of ventilation withdrawal was counted,and the patients were divided into successful and failed groups according to whether the withdrawal was successful or not.The levels of CRP and RSBI immediately before the withdrawal were compared between the two groups.Receiver operating characteristic(ROC)curve was made to analyze the predictive value of CRP combined with RSBI for mechanical ventilation withdrawal failure of AECOPD with respiratory failure.Results Among 146 AECOPD patients with respiratory failure,42 patients failed to withdraw from the machine,with an incidence of 28.77%.Univariate analysis showed that there were significant differences in MODS,age,CRP and RSBI levels between the two groups(χ^(2)=4.38,t=2.21,t=11.98,t=9.78,respectively,all P<0.05).Logistic regression analysis showed that age>60 years old(OR=1.732,95%CI:1.042-2.386),CRP>10 mg/L(OR=1.863,95%CI:1.131-3.101)and RSBI>105 times·min^(-1)·L^(-1)(OR=2.152,95%CI:1.021-3.661)levels were the influential factors of ventilator withdrawal failure.ROC curve analysis showed that the best cut-off points of CRP and RSBI for predicting weaning failure in patients with AECOPD and respiratory failure were 12.18 mg/L and 78.96 times·min^(-1)·L^(-1),respectively.The sensitivity and specificity of CRP combined with RSBI were 78.57%and 97.12%,respectively,in predicting the failure of mechanical ventilation withdrawal with AECOPD and respiratory failure,which were higher than that of CRP and RSBI alone.The area under the curve of CRP combined with RSBI for predicting weaning failure of mechanical ventilation in AECOPD with respiratory failure was 0.926,which was higher than that of CRP and RSBI alone(P<0.05).Conclusions CRP and RSBI have high efficacy in predicting the failure of mechanical ventilation withdrawal with AECOPD combined with respiratory failure.The combination of CRP and RSBI can predict the withdrawal failure of mechanical ventilation with AECOPD combined with respiratory failure.