自主呼吸试验期间B型钠尿肽变化百分比对有创机械通气患者脱机结局预测价值的Meta分析

目的探讨自主呼吸试验（SBT）期间B型钠尿肽水平变化百分比（BNP%）对有创机械通气患者的预测价值。 方法检索PubMed、Embase、Medline、Ovid、Cochrane Central Register of Controlled Trails和the Information Sciences Institute Web of Science从建库开始到2018年3月31日发表的有关BNP%预测有创机械通气患者脱机结局文献。采用Quasas-2工具对文献进行质量评价，采用MetaDiSc软件进行异质性分析，并计算合并诊断比值比（DOR）、合并敏感度、合并特异度、合并阳性似然比（PLR）及合并阴性似然比（NLR）。同时绘制合并受试者工作特征（SROC）曲线，获得曲线下面积。 结果纳入5篇文献，共213名患者。Meta分析结果显示，合并DOR为22.33 [95%置信区间（CI）（9.25，53.91）]，合并敏感度为85%[95%CI（0.78，0.91）]，合并特异度为80%[95%CI（0.68，0.90）]，合并PLR为3.72 [95%CI（2.11，6.55）]，合并NLR为0.18 [95%CI（0.12,0.28）]。且合并DOR、合并敏感度、合并特异度、合并PLR、合并NLR分析均提示无明显异质性（P均> 0.1，I²均< 50%），SROC曲线下面积为0.913。 结论BNP%对SBT期间有创机械通气患者脱机结局预测价值的诊断准确度高。

Predictive value of percent change in brain natriuretic peptide for endotracheal tube extubation in invasive mechanically ventilated patients during spontaneous breathing trial: a meta-analysis

ObjectiveTo assess the predictive value of percent change in brain natriuretic peptide (BNP%) for endotracheal tube extubation in invasive mechanically ventilated patients during spontaneous breathing trial (SBT). MethodsSearches were conducted in the PubMed, Embase, Medline, Ovid, Cochrane Central Register of Controlled Trails and Information Sciences Institute Web of Science for studies on the predictive value of BNP% for endotracheal tube extubation in invasive mechanically ventilated patients published up to March 31, 2018. The Quality Assessment of Diagnostic Accuracy Studies (Quasas-2) was used for quality assessment. The MetaDiSc was used for heterogeneity analysis, and the pooled diagnostic odds ratio (DOR), pooled sensitivity, pooled specificity, pooled positive likelihood ratio (PLR), pooled negative likelihood ratio (NLR), and the area under the summary receiver operating characteristic (SROC) curve were calculated. ResultsA total of 213 patients were recruited from 5 trials. Meta-analysis showed that the pooled DOR was 22.33 [95% confidence interval (CI) (9.25, 53.91)], the pooled sensitivity was 85% [95%CI (0.78, 0.91)], the pooled specificity was 80% [95%CI (0.68, 0.90)], the pooled PLR was 3.72 [95%CI (2.11, 6.55)], and the pooled NLR was 0.18 [95%CI (0.12, 0.28)]. The pooled DOR, sensitivity, specificity, PLR, and NLR showed no significant heterogeneity (all P > 0.1, all I² < 50%), and the area under the SROC curve was 0.913. ConclusionBNP% can elevate the predictive value for endotracheal tube extubation in invasive mechanically ventilated patients during SBT.