膈肌相关浅快呼吸指数指导ICU患者撤离呼吸机的临床研究

doi:10.3969/j.issn.1002-1949.2019.01.007

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摘要目的比较传统浅快呼吸指数（rapid shallow breathing index， RSBI）与膈肌相关浅快呼吸指数（diaphragmatic-RSBI， D-RSBI）预测撤机失败的准确性，探讨D-RSBI对ICU患者撤离呼吸机的指导价值。方法采用前瞻性研究方法，选择2017年6月至2018年3月天津医科大学第二医院重症医学科接受有创机械通气治疗的31例患者。自主呼吸试验（spontaneous breathing trial， SBT）1 h后测量并记录患者呼吸频率、潮气量、血气分析及右侧膈肌移动度。根据撤机结果，将患者分为成功组和失败组，分别计算出每组患者的RSBI及D-RSBI，采用受试者工作特征（ROC）曲线分析RSBI及D-RSBI对撤机失败预测的准确性。〖HTH〗结果〓〖HTSS〗纳入本次研究的31例患者中，25例撤机成功（81%），6例撤机失败（19%）。使用ROC曲线分析D-RSBI及RSBI两组连续变量得出的结果如下：D-RSBI预测撤机失败的准确性较高，ROC曲线下面积0.87，利用约登指数计算出D-RSBI的临界值为1.8 次/（min·mm），即D-RSBI＞1.8 次/（min·mm）预测患者撤机失败敏感性66.7%，特异性96.2%，阳性预测值88.3%，阴性预测值87.1%。RSBI次之，ROC曲线下面积0.80，与D-RSBI预测撤机失败的ROC曲线下面积差异有统计学意义（P＜0.05），临界值为92.3 次/（min·L），即RSBI＞92.3 次/（min·L）预测患者撤机失败敏感性100%，特异性68%，阳性预测值57.2%，阴性预测值100%。结论 D-RSBI及RSBI是预测撤机失败的良好指标，D-RSBI预测撤机失败的准确性高于RSBI。

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	冯辉
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关键词 ：机械通气, 撤机, 膈肌移动度, 浅快呼吸指数

通讯作者: 陈兵（1967-），男，硕士，主任医师，E-mail:tisheng2008@163.com。

作者简介: 冯辉（1987-），男，硕士研究生，E-mail:fhh_1987@sina.com。

引用本文:

冯辉，陈兵，田晶，刘毅. 膈肌相关浅快呼吸指数指导ICU患者撤离呼吸机的临床研究[J]. 中国急救医学, 2019, 39(1): 34-37.
Feng Hui, Chen Bing, Tian Jing, Liu Yi. A clinical study about D-RSBI directed weaning in the ICU patients undergoing mechanical ventilation. Chinese Journal of Critical Care Medicine, 2019, 39(1): 34-37.

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http://www.cnemergency.org.cn/CN/10.3969/j.issn.1002-1949.2019.01.007 或 http://www.cnemergency.org.cn/CN/Y2019/V39/I1/34

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