中心静脉血氧饱和度预测困难脱机结果的临床研究

发布时间：2018-05-08 10:20

  本文选题：中心静脉血氧饱和度 + 机械通气　； 参考：《天津医科大学》2014年硕士论文

【摘要】：目的探讨中心静脉血氧饱和度(central venous oxygen saturation,ScvO2)对困难脱机患者脱机结果的预测价值。 方法将184例困难脱机患者进行的214例次脱机,按脱机结果分为脱机成功组和脱机失败组,按转入ICU时是否患有心功能不全分层为心功能不全组和非心功能不全组。记录患者的年龄、入院时的APACHEⅡ评分、死亡风险系数、脱机前的氧合指数(OI),在断开呼吸机即刻记录患者的心率(HR)、呼吸频率(RR)、血压(Bp)、氧饱和度(SpO2),分别取外周动脉血和中心静脉血查血气,得到动脉血氧饱和度(SaO2)及ScvO2。在自主呼吸实验(spontaneous breathing trail,SBT)第30min时重复上述操作步骤,将断开呼吸机即刻的ScvO2减去SBT第30min的ScvO2,所得到的差值记为ΔScvO2。分析这些参数在脱机成功组与脱机失败组之间的差异,判断哪些指标对脱机结果有影响。 结果(1)所有214例次脱机在SBT第30min的ScvO2与ΔScvO2在脱机成功组与脱机失败组间有差异(74.6±6.6VS71.4±5.5,p0.05及2.76±4.16VS4.634±3.71, p0.05),其余各参数在脱机成功组与脱机失败组之间无差异。ΔScvO2预测脱机失败的临界值为3.65%,敏感性为73.3%,特异性为60.3%。(2)分层分析显示：仅有SBT第30min的ScvO2与ΔScvO2在心功能不全组脱机成功患者与脱机失败患者间有差异(73.6±5.2VS70.4±5.2,p0.05与2.61±3.13VS5.08±2.38,p0.01),其余参数在心功能不全组以及非心功能不全组均没有差异。ΔScvO2预测心功能不全患者脱机失败的临界值值为4.0%,敏感性为85.0%,特异性为73.6%。 结论SBT第30min的ScvO2与ΔScvO2能够预测困难脱机患者的脱机结果；分层分析显示SBT第30min的ScvO2和ΔScvO2仅对心功能不全患者脱机失败有预测价值,可将ΔScvO2≥4.0%作为预测心功能不全患者脱机失败的预测指标之一。
[Abstract]:Objective to investigate the value of central venous oxygen saturation (scvO2) in predicting the weaning results in patients with difficult weaning. Methods one hundred and fourteen patients with difficulty weaning were divided into two groups according to the results of weaning: successful weaning group and failed weaning group. According to whether the patients suffered from cardiac insufficiency or not were divided into cardiac insufficiency group and non-cardiac insufficiency group according to whether they were suffering from cardiac insufficiency at the time of transfer to ICU. The age of the patient, the APACHE 鈪，

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