呼吸科危重症患者机械通气撤机结局与进行自主呼吸试验前维生素D水平的关系

The relationship between the outcome of mechanical ventilation weaning in critically ill patients in the department of respiratory and vitamin D level before spontaneous breathing test

目的探讨呼吸科危重症患者机械通气撤机结局与进行自主呼吸试验(SBT)前维生素D水平的关系。方法用便利抽样法选择2018年4月至2021年5月于该院呼吸科住院治疗的危重症且行机械通气的患者80例为研究对象。采用双抗体夹心法对患者入院时、进行SBT前6 h的血清25羟基维生素D3[25(OH)D3]水平进行检测。根据患者的撤机结局,分为撤机失败组(27例)及撤机成功组(53例),比较两组患者的临床资料;采用多因素Logistic回归分析患者撤机结局的影响因素;采用受试者工作特征曲线分析25(OH)D3水平对撤机结局的预测价值;采用Spearman相关分析患者进行SBT前25(OH)D3水平与撤机结局的相关性。结果撤机失败组的急性生理和慢性健康状况评分系统Ⅱ(APACHEⅡ)评分,进行SBT前的呼吸频率、呼吸浅快指数(RSBI)、N-末端脑钠肽前体(NT-proBNP)、C反应蛋白(CRP)水平均高于撤机成功组,但入院时及进行SBT前的25(OH)D3水平均低于撤机成功组,差异有统计学意义(P<0.05)。撤机失败的危险因素为APACHEⅡ评分及进行SBT前的RSBI、NT-proBNP水平升高,进行SBT前的25(OH)D3水平降低(P<0.05)。进行SBT前的25(OH)D3水平用于预测撤机结局的曲线下面积为0.813,灵敏度为74.07%,特异度为79.25%,截断值为17.00 nmol/L。进行SBT前的25(OH)D3水平与撤机结局呈负相关(r=-0.531,P<0.001)。结论呼吸科危重症患者的撤机结局与进行SBT前的维生素D水平密切相关,可于行SBT前6 h进行维生素D水平监测,用于预测患者撤机失败风险。

Objective To investigate the relationship between the outcome of mechanical ventilation weaning in critically ill patients in the department of respiratory and vitamin D level before spontaneous breathing test(SBT).Methods A convenience sampling method was used to select 80 critically ill patients who underwent mechanical ventilation in the department of respiratory medicine of the hospital from April 2018 to May 2021 as the research objects.The serum 25-hydroxyvitamin D3[25(OH)D3]level was detected by double antibody sandwich method on admission and 6 h before SBT.According to the weaning outcome of the patients,they were divided into the weaning failure group(27 cases)and the weaning success group(53 cases),and the clinical data of the two groups of patients were compared.Multivariate Logistic regression was used to analyze the influencing factors of weaning outcome.Receiver operating characteristic curve was used to analyze the predictive value of 25(OH)D3 level on weaning outcome.Spearman correlation was used to analyze the correlation between 25(OH)D3 levels before SBT and weaning outcome in patients.Results Acute physiology and chronic health evaluation Ⅱ(APACHEⅡ)score,respiratory rate,rapid shallow breathing index(RSBI),oxygenation index,N-terminal pro-brain natriuretic peptide(NT-proBNP)and C-reactive protein(CRP)levels before SBT in the weaning failure group were higher than those in the weaning success group,but the 25(OH)D3 levels at admission and before SBT were lower than those in the weaning success group,the differences were statistically significant(P<0.05).The risk factors of weaning failure were APACHEⅡ score,RSBI and NT-proBNP level before SBT increased,and 25(OH)D3 level before SBT decreased(P<0.05).The area under the curve of 25(OH)D3 before SBT for predicting weaning outcome was 0.813,the sensitivity was 74.07%,the specificity was 79.25%,and the cut-off value was 17.00 nmol/L.The level of 25(OH)D3 before SBT was negatively correlated with weaning outcome(r=-0.531,P<0.001).Conclusion The weaning outcome of critically ill patients in the department of respiratory is closely related to the vitamin D level before SBT,and vitamin D level monitoring could be performed 6 h before SBT to predict the risk of weaning failure.