自主呼吸试验前后N端脑钠肽前体差值对非心源性危重症机械通气患者撤机结局的预测价值.docVIP

自主呼吸试验前后N端脑钠肽前体差值对非心源性危重症机械通气患者撤机结局的预测价值 　　[摘要] 目的 探讨自主呼吸试验前后NT-proBNP差值对非心源性危重症机械通气患者撤机结局的预测价值。 方法 选取2013年1月～2014年10月在本院内科ICU病房接受机械通气治疗的60例非心源性危重症患者作为研究对象，按照撤机结局分为成功组（n=49）和失败组（n=11）。采用受试者工作特征（ROC）曲线评价自主呼吸试验前后NT-proBNP差值预测撤机成功率的价值。 结果 成功组自主呼吸试验后的NT-proBNP水平显著低于失败组，差异有统计学意义（P0.01）。成功组自主呼吸试验前后的NT-proBNP差值显著低于失败组，差异有统计学意义（P0.01）。自主呼吸试验前后NT-proBNP差值预测撤机失败的ROC曲线下面积为0.935±0.035，以NT-proBNP上升581.5 pg/ml为拐点，预测撤机成功的灵敏度为90.9%，特异度为87.8%。 结论 自主试验前后NT-proBNP的变化可作为撤机结局的一种预测指标，联合自主呼吸试验能提高撤机的成功率。 　　[关键词] N端脑钠肽前体；自主呼吸试验；受试者工作特征曲线；撤机 　　[中图分类号] R459.9 [文献标识码] A [文章编号] 1674-4721（2015）08（b）-0025-04 　　Predicting value of the difference between the NT-proBNP before and after the spontaneous breathing trial on weaning outcome of the non-cardiogenic critical illness patients with mechanical ventilation 　　ZHANG Xiu-zhen CHEN Li-xia LIANG Wei-hua TAN Guang-zhang YANG Zhi-peng CHEN Yang-guo 　　The Second People′s Hospital of Xinhui Distinct of Jiangmen City in Guangdong Province，Jiangmen 529100，China 　　[Abstract] Objective To explore the predicting value of the difference between the NT-proBNP before and after the spontaneous breathing trial on weaning outcome of the non-cardiogenic critical illness patients with mechanical ventilation. Methods 60 non-cardiogenic critical illness patients with mechanical ventilation in the department of internal medicine in our hospital from January 2013 to December 2014 were selected and divided into the success group （n=49） and the failure group （n=11）according to the outcome of weaning.The value of NT-proBNP difference in predicting the success rate of weaning was evaluated by using receiver operating characteristic （ROC） curve. Results The level of NT-proBNP after the spontaneous breathing trial in the success group was lower than that in the failure group，with significant difference（P 　　[Key words] NT-proBNP；Spontaneous breathing trial；ROC cure；Weaning 　　机械通气患者的成功脱机与心肺功能、感染程度等因素密切相关，造成脱机失败最常见的原因包括心脏容量负荷过重、心功能不全[1]。N端脑钠肽前体（NT-proBNP）是临床上用于判断心功能