COPD合并Ⅱ型呼吸衰竭患者血清磷、降钙素原、25-羟维生素D_(3)水平与机械通气撤机结局的关系研究

Relationship Research between the Levels of Serum Phosphorus,Procalcitonin,25-Hydroxyvitamin D_(3) and the Mechanical Ventilation Withdrawal Outcomein Patients with COPD Complicated with Type Ⅱ Respiratory Failure

目的:探讨慢性阻塞性肺疾病(COPD)合并Ⅱ型呼吸衰竭患者血清磷(P)、降钙素原(PCT)、25-羟维生素D_(3)[25(OH)D_(3)]水平对机械通气撤机结局的影响。方法:选取2020年3月-2021年3月我院收治的接受机械通气治疗的COPD合并Ⅱ型呼吸衰竭患者117例,根据撤机结局分为撤机成功组(n=91)和撤机失败组(n=26),比较两组患者的临床资料、自主呼吸测试(SBT)前的血清P、PCT、25(OH)D_(3)水平,多因素Logistic回归分析撤机失败的影响因素,受试者工作特征(ROC)曲线分析血清P、PCT、25(OH)D_(3)水平对撤机失败的预测价值。结果:两组患者在机械通气时间、入住重症监护室(ICU)时间、急性生理学及慢性健康状况评分系统Ⅱ(APACHEⅡ)评分方面差异有统计学意义(P<0.05);SBT前撤机成功组血清25(OH)D_(3)、P水平高于撤机失败组,PCT水平低于撤机失败组(P<0.05);多因素Logistic回归分析结果显示:PCT、25(OH)D_(3)、P、机械通气时间均是撤机失败的影响因素(P<0.05);ROC曲线分析结果显示:血清PCT、25(OH)D_(3)、P水平预测撤机失败的曲线下面积(AUC)分别为0.687、0.802、0.751,均低于三者联合应用的0.846。结论:血清P、PCT、25(OH)D_(3)均是COPD合并Ⅱ型呼吸衰竭患者机械通气撤机结局的影响因素,检测以上指标水平有助于预测患者机械通气撤机结局。

Objective:To investigate the effects of the levels of serum phosphorus(P),procalcitonin(PCT)and 25-hydroxyvitamin D_(3)[25(OH)D_(3)]on the mechanical ventilation withdrawal outcome in patients with chronic obstructive pulmonary disease(COPD)complicated with type Ⅱ respiratory failure.Methods:A total of 117 patients with COPD complicated with type Ⅱ respiratory failure who were treated with mechanical ventilation in our Hospital from March 2020 to March 2021 were selected,and they were divided into successful withdrawal group(n=91)and failed withdrawal group(n=26)according to withdrawal outcome.Clinical data and the levels of serum P,PCT,25(OH)D_(3)before spontaneous breathing test(SBT)were compared between the two groups.Multivariate Logistic regression analysis was used to analyze the influencing factors of withdrawal failure.Receiver operating Characteristic curve(ROC)was used to analyze the predictive value of levels of serum P,PCT,25(OH)D_(3)for withdrawal failure.Results:There were statistically significant differences in mechanical ventilation time,admission to intensive care unit(ICU)time and Acute physiology and chronic health scoring systemⅡ(APACHE Ⅱ)score between two groups(P<0.05).The levels of serum 25(OH)D_(3)and P before SBT in the successful withdrawal group were higher than those in the failed withdrawal group,and the level of PCT was lower than that in the failed withdrawal group(P<0.05).Multivariate Logistic regression analysis showed that mechanical ventilation time,PCT,25(OH)D_(3),P were the independent influencing factors(P<0.05).The ROC curve analysis results show that the area under the curve(AUC)of PCT,25(OH)D_(3)and P predicting the withdrawal failure were 0.687,0.802 and 0.751 respectively,which were lower than the AUC of the combined detection of PCT,25(OH)D_(3)and P,which was 0.846.Conclusion:Serum P,PCT and 25(OH)D_(3)are the influencing factors of the mechanical ventilation withdrawal outcome in COPD patients with type Ⅱ respiratory failure.Detecting the above index levels can effectively predict the mechanical ventilation withdrawal outcome.