摘要
目的 探讨血浆NT-proBNP对老年肺心病合并呼吸困难患者顺利脱机拔管的预测价值.方法 选择2009-01～2010-05入住综合ICU的51例经过气管插管机械通气治疗≥3 d 的肺心病合并呼吸困难老年患者,检测所有患者在气管插管机械通气时、机械通气第3天血浆NT-proBNP浓度,当患者达到脱机拔管条件时行SBT试验,其中通过SBT试验后48 h内无需复插或通气支持为脱机成功组,未通过SBT试验及通过SBT试验但48 h内再次复插或需通气支持为脱机失败组,绘制受试者工作特征（ROC）曲线,分析气管插管机械通气时、机械通气第3天血浆NT-proBNP浓度及其差值对顺利脱机拔管的预测价值.结果 51例老年肺心病合并呼吸困难患者气管插管机械通气时血浆NT-proBNP浓度的AUC为0.794,机械通气第3天血浆NT-proBNP浓度的AUC为0.612,两者差值的AUC为0.833,两者差值的AUC显著高于机械通气第3天血浆NT-proBNP浓度的AUC（P＜0.05）.结论 动态监测NT-proBNP对肺心病合并呼吸困难患者的顺利脱机拔管有较好的预测作用;机械通气时与机械通气第3天血浆NT-proBNP浓度差值对能否顺利脱机拔管具有较好的预测价值.
Objective To evaluate the predictive value of serial measurements of plasma N - terminal pro - brain natriuretic peptide （ NT - proBNP） in the prognosis of cor pulmonale patients with dyspnea after successful weaning. Methods Fifty - one eor pulmonale patients with dyspnea had mechanical ventilation for at least 3 days. Serum NT - proBNP was detected before mechanical ventilation and at 3rd day after mechanical ventilation. When the clinical data of the patients fulfilled the criteria for weaning from MV, the patients who weaned and extubated successfully within 48 h and who failed were divided into success group and failure group respectively. The receiver operating characteristic （ROC） curves were constructed according to data of serum NT - proBNP and successful rate to predict the value of NT - proBNP. Results In the ROC curves, AUC value of NT - proBNP1, NT - proRNP3 and NT - proBNPO were 0. 794, 0. 612 and 0. 833. The difference in areas of these curves between NT - proBNPO and NT - proBNP3 were significantly different （ P 〈 0.05 ）. Conclusion Serial measurements of plasma N - terminal pro - brain natriuretic peptide （ NT - proBNP ） has a better prognostic value for weaning outcome among cor pulmonale patients with dyspnea. NT - proBNPO can be used to predict weaning from MV for cor pulmonale patients with dyspnea.
出处
《中国急救医学》
CAS
CSCD
北大核心
2011年第4期303-306,共4页
Chinese Journal of Critical Care Medicine
关键词
氨基末端脑钠肽前体
肺心病
机械通气
受试者工作特征曲线
N - terminal pro - brain natriuretic peptide （ NT - proBNP）
Cor pulmonale
Mechanicalventilation
Receiver operating characteristic curves（ROC）
