NT-proBNP与PiCCO参数对重症机械通气患者困难撤机结局的预测价值

发布时间：2018-10-16 20:20

【摘要】：目的：评估血清氨基末端-脑钠肽前体(NT-proBNP)水平和脉搏指示连续心输出量(PiCCO)参数在困难撤机的危重患者中对撤机结局的预测价值。 方法：采用前瞻性观察方法,纳入2013年1月至2014年2月期间由湘雅医院重症医学科收治的接受有创机械通气超过24小时并行PiCCO股动脉置管的成年患者。根据2001年美国撤机指南对达到撤机标准的患者施行自主呼吸试验(SBT),通过者予拔管并严密观察48小时。分别比较不同SBT结局(成功／失败)以及不同撤机结局(成功／失败)患者的液体平衡、血气分析结果、NT-proBNP及PiCCO参数的差异,并评估各指标对患者SBT结局或撤机结局的诊断或预测价值。 结果：共34例患者符合本研究纳入标准,包括男性20例(58.8%)和女性14例(41.2%),其平均APACHE Ⅱ评分为21.6±1.4分,进行SBT前有创机械通气的中位时间为67.5(39,528)小时。根据SBT结局,将患者分为SBT成功组(n=28例,82.4%)与SBT失败组(n=6例,17.7%),对SBT结局具有较高诊断价值的指标包括：SBT前24小时液体量[ROC曲线下面积(AUC)=0.815±0.107, P=0.017]、SBT前每日液体量(AUC=0.940±0.040, P=0.001). SBT开始前NT-proBNP (AUC=0.777±0.095, P=0.036)、SBT结束时NT-proBNP(AUC=0.875±0.060, P=0.004)、SBT过程中NT-proBNP变化量ANT-proBNP (AUC=0.964±0.032, P0.001)、SBT过程中全心舒张末容积指数(GEDVI)的变化量AGEDVI (AUC=0.818±0.091, P=0.016)、以及肺血管通透指数(PVPI)(AUC=0.905±0.061, P=0.002)。另外,根据拔管后48小时内撤机结局将患者分为撤机成功组(n=16例,47.1%)与撤机失败组(n=18例,52.9%),对撤机结局具有显著的预测价值的指标包括：SBT前每日液体量(AUC=0.733±0.090,P=O.021).△GEDVI(AUC=0.714±0.088,P=0.034).血管外肺水指数(EVLWI)(AUC=0.799±0.076,P=0.003)和PVPI(AUC=0.873±0.058, PO.001). 结论：与NT-proBNP或其他传统容量指标相比,PiCCO参数对困难撤机的危重患者撤机结局具有更高的预测价值。
[Abstract]:Objective: to evaluate the predictive value of serum amino-terminal brain natriuretic peptide precursor (NT-proBNP) and pulse indicator continuous cardiac output (PiCCO) parameters in patients with critical patients with difficult weaning. Methods: prospective observation was used to include adult patients who received invasive mechanical ventilation for more than 24 hours and PiCCO femoral artery catheterization from January 2013 to February 2014. According to the 2001 American guidelines for weaning, the patients who met the weaning standard were given extubation and closely observed for 48 hours if (SBT), passed. The fluid balance, blood gas analysis, NT-proBNP and PiCCO parameters of patients with different SBT outcomes (success / failure) and different weaning outcomes (success / failure) were compared, respectively. To evaluate the diagnostic and predictive value of each index in patients with SBT outcome or weaning outcome. Results: a total of 34 patients met the criteria of this study, including 20 males (58.8%) and 14 females (41.2%). The average APACHE 鈪，

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