中心静脉-动脉血二氧化碳分压差及中心静脉血氧饱和度对住院危重患者拔管失败的预测价值

Predictive value of central venous-arterial carbon dioxide partial pressure difference and central venous oxygen saturation in the extubation failure of hospitalized critical patients

目的探讨中心静脉-动脉血二氧化碳分压差[pressure(central venous-arterial)carbon dioxide,P(cv-a)CO_(2)]、中心静脉血氧饱和度(central venous oxygen saturation,ScvO_(2))对重症监护室(ICU)机械通气(MV)患者拔管失败的预测效能。方法选择2017年7月至2021年3月在周口骨科医院ICU行MV治疗的患者147例,根据ICU患者拔管结局将其分为拔管成功组和拔管失败组。对比分析两组患者的一般资料及拔管前后的血流动力学参数、呼吸参数和血气分析参数。应用受试者工作特征(ROC)曲线分析P(cv-a)CO_(2)拔管前后差值[ΔP(cv-a)CO_(2)]和ScvO_(2)拔管前后差值(ΔScvO_(2))对MV患者拔管失败的预测评估价值。结果年龄≥60岁、MV应用时间≥7 d、感染、ΔP(cv-a)CO_(2)≥40%是危重患者拔管失败的危险因素;ΔScvO_(2)≤5.4%是危重患者拔管失败的保护因素。ΔP(cv-a)CO_(2)、ΔScvO_(2)和ΔP(cv-a)CO_(2)联合ΔScvO_(2)预测患者拔管失败的ROC曲线下面积(AUC)(95%CI)分别为0.802(0.649~0.952)、0.803(0.659~0.938)、0.884(0.782~0.982)。结论ΔP(cv-a)CO_(2)和ΔScvO_(2)是预测危重患者拔管失败的独立危险因素,ΔP(cv-a)CO_(2)和ΔScvO_(2)的联合预测价值高于单独应用。

Objective To evaluate the predictive value of central venous-arterial carbon dioxide partial pressure difference[P(cv-a)CO_(2)]and central venous oxygen saturation(ScvO_(2))in the extubation failure(EF)of ICU patients with mechanical ventilation(MV).Methods ICU patients were divided into extubation success(ES)and EF group according to extubation outcome.The general data,hemodynamic parameters,respiratory parameters and blood gas analysis parameters before and after extubation were compared and analyzed between the two groups.ROC was used to analyze the predictive value of P(cv-a)CO_(2) difference before and after extubation[ΔP(cv-a)CO_(2)]and ScvO_(2) difference before and after extubation(ΔScvO_(2))in the EF of MV patients.Results Age≥60 years old,MV application time≥7 days,infection andΔP(cv-a)CO_(2)≥40%were the risk factors of EF in critically ill patients.ΔScvO_(2)≤5.4%was the protective factor of EF in critically ill patients.The AUC(95%CI)ofΔP(cv-a)CO_(2)、ΔScvO_(2)、ΔP(cv-a)CO_(2) combined withΔScvO_(2) for predicting patients'EF were 0.802(0.649-0.952),0.803(0.659-0.938)and 0.884(0.784-0.982),respectively.ConclusionsΔP(cv-a)CO_(2) andΔScvO_(2) were independent predictors of EF in critically ill patients.The value of combined prediction ofΔP(cv-a)CO_(2) andΔScvO_(2) is higher than that of single application.