摘要
目的:分析综合撤机指数(IWI)、气道闭合压结合呼吸系统功能评分对慢性阻塞性肺疾病(COPD)合并呼吸衰竭(RF)患者撤机困难的预测价值。方法:回顾性选取98例COPD合并RF患者的临床资料,根据撤机结局进行分组,其中撤机困难患者30例(30.61%),撤机成功患者68例(69.39%)。使用多因素Logistic回归分析导致COPD合并RF患者撤机困难的危险因素。绘制受试者工作特征(ROC)曲线,以曲线下面积(AUC)评估IWI、气道闭合压及呼吸系统功能评分对COPD合并RF患者撤机困难的预测价值。结果:困难组和成功组年龄、机械通气时间、浅快呼吸指数IWI、气道闭合压及呼吸系统功能评分比较,差异有统计学意义(均P<0.05)。Logistic回归分析结果显示,IWI降低、气道闭合压及呼吸系统功能评分升高是导致COPD合并RF患者撤机困难的独立危险因素(均P<0.05)。ROC曲线结果显示,IWI、气道闭合压和呼吸系统功能评分预测COPD合并RF患者撤机困难的AUC分别为0.811、0.794、0.618,三者联合(并联)的AUC为0.917(95%CI:0.843~0.963),敏感度为93.33%,特异度为83.82%,联合因子AUC显著高于单独指标(Z=3.077、2.486、2.978,均P<0.05)。结论:IWI、气道闭合压及呼吸系统功能评分与COPD合并RF患者撤机结局呈明显相关性,可用于评估患者撤机困难可能,联合检测有助于提高预测准确性。
Objective:To analyze the predictive value of integrated weaning index(IWI),airway occlusion pressure combined with respiratory system function score for weaning difficulty in patients with chronic obstructive pulmonary disease(COPD)and respiratory failure(RF).Methods:The clinical data of 98 patients with COPD and RF were retrospectively collected.Patients enrolled were divided into difficult group(30 cases)and successful group(68 cases)according to the outcome of weaning.Multivariate Logistic regression was used to analyze the risk factors for difficult weaning in patients with COPD and RF.The receiver operating characteristic(ROC)curves were plotted and the areas under curve(AUC)were calculated to evaluate the predictive value of IWI,airway occlusion pressure,and respiratory system function score for difficult weaning in patients with COPD and RF.Results:There were statistically significant differences in age,mechanical ventilation time,rapid shallow breathing index(RSBI),IWI,airway occlusion pressure,and respiratory system function score between the difficult group and the successful group(all P<0.05).Logistic regression analysis results showed that decreased IWI,increased airway occlusion pressure,and elevated respiratory system function score were independent risk factors for difficult weaning in patients with COPD and RF(all P<0.05).ROC curve analysis results showed that the AUCs of IWI,airway occlusion pressure,and respiratory system function score for predicting difficult weaning in patients with COPD and RF were 0.811,0.794,and 0.618,respectively.The AUC of combination(in parallel)of the three was 0.917(95%CI:0.843-0.963).The sensitivity and specificity were 93.33%and 83.82%.The AUC of combined use of indicators was significantly greater than that of each indicator(Z=3.077,2.486,2.978,all P<0.05).Conclusion:IWI,airway occlusion pressure,and respiratory system function score are significantly correlated with the outcome of weaning in patients with COPD and RF.They can be used to assess the possibility of difficult weaning,and combined use can improve the accuracy of prediction.
作者
李鹏
汪亮
颜刚林
吴竞
LI Peng;WANG Liang;YAN Ganglin;WU Jing(Department of Emergency,Chaohu Hospital of Anhui Medical University,Hefei 238000,China;Department of Neurosurgery,Chaohu Hospital of Anhui Medical University,Hefei 238000,China;Department of Respiratory and Critical Care,Chaohu Hospital of Anhui Medical University,Hefei 238000,China)
出处
《陕西医学杂志》
2025年第10期1360-1364,1399,共6页
Shaanxi Medical Journal
基金
安徽省重点研究与开发计划项目(2022e07020058)。
关键词
综合撤机指数
气道闭合压
呼吸系统功能评分
慢性阻塞性肺疾病
呼吸衰竭
撤机结局
Integratied weaning index
Airway occlusion pressure
Respiratory system function score
Chronic obstructive pulmonary disease
Respiratory failure
Outcome of weaning
