浅快呼吸指数预测ICU中COPD患者撤机的临床价值

目的研究浅快呼吸指数（rapid shallow breathing index,RSBI）对重症监护病房（intensive care unit,ICU）中慢性阻塞性肺疾病（chronic obstructive pulmonary disease,COPD）患者撤机的临床价值。方法回顾性分析2009年6月～2011年5月在ICU住院使用机械通气并准备撤机的30例COPD患者。监测患者的潮气量（volume tidal,VT）和呼吸频率（respiratory rate,RR）,并计算RSBI。患者入ICU后当日对其进行APACHEⅡ（acute physiological and chronichealth evaluationⅡ）评分。根据是否成功分为撤机成功组（18例）和撤机失败组（12例）。计算撤机指标的灵敏性和特异性。分析年龄、APACHEⅡ、RSBI三者间的相关性。结果撤机成功组年龄为（70.44±9.00）岁,撤机失败组年龄为（76.58±8.80）岁,两组间年龄比较差异无统计学意义（P﹥0.05）;撤机成功组APACHEⅡ评分为（15.11±5.11）分,撤机失败组为（24.17±6.31）分,两组间APACHEⅡ评分比较差异有高度统计学意义（P〈0.01）;撤机成功组RSBI为（77.88±8.94）次/（min·L）,撤机失败组为（99.53±12.14）次/（min·L）,撤机成功组RSBI明显低于撤机失败组RSBI,两组比较,差异有高度统计学意义（P〈0.01）。预测COPD患者撤机成功的灵敏性为94.4%,特异性为70.6%,正确率为96.7%。患者年龄与APACHEⅡ评分呈正相关（r=0.417,P〈0.05）;年龄与RSBI呈显著正相关（r=0.470,P〈0.01）;APACHEⅡ评分与RSBI呈显著正相关（r=0.678,P〈0.01）。结论 RSBI对COPD患者呼吸机撤离有一定的指导意义,但并非敏感指标,结合临床其他指标可能更可靠。

Clinical value of rapid shallow breathing index in predicting ventilator weaning of the patients with chronic obstructive pulmonary disease in ICU

Objective To study the clinical value of rapid shallow breathing index(RSBI) in predicting ventilator weaning of chronic obstructive pulmonary disease(COPD) patients in intensive care unit(ICU).Methods 30 cases of COPD patients admitted to ICU in our hospital from June 2009 to May 2011 with mechanical ventilation and preparing to remove were retrospectively analyzed.Volume tidal(VT),respiratory rate(RR) and RSBI were observed,and acute physiological and chronic health evaluation Ⅱ(APACHE Ⅱ) was scored when the patients were admitted to ICU during their first day.All participants were divided into two groups: ventilator weaning success group(n = 18) and ventilator weaning failure group(n = 12).Sensitivity and specificity of the indexes were calculated and correlations among age,APACHE Ⅱ and RSBI were analyzed.Results Age in ventilator weaning success group and ventilator weaning failure group were(70.44±9.00) and(76.58±8.80),which showed no significant difference(P > 0.05).Scores of APACHE Ⅱ in ventilator weaning success group and ventilator weaning failure group were(15.11±5.11) and(24.17±6.31),and there was remarkable statistical difference(P < 0.01).RSBI in ventilator weaning success group was(77.88±8.94) times/(min·L) while in ventilator weaning failure group was(99.53±12.14) times/(min·L),and the index in the former group was obviously lower than that of the latter one,which displayed a significant difference between the two groups(P < 0.01).Sensitivity,specificity,and accuracy in predicting successful ventilator weaning of COPD patients were 94.4%,70.6% and 96.7% respectively.There were positive correlation between age and APACHE Ⅱ(r = 0.417,P < 0.05),age and RSBI(r = 0.470,P < 0.01),and APACHE Ⅱ and RSBI(r = 0.678,P < 0.01).Conclusion RSBI has certain guidance in ventilator weaning of COPD patients,but it is not a sensitivity index.Together with other clinical indexes,the result may be more credible.