下腔静脉变异度和中心静脉血氧饱和度变化率对机械通气患者撤机的预测价值

目的探讨下腔静脉变异度(ΔDIVC)和中心静脉血氧饱和度变化率(ΔSCVO 2)对机械通气患者撤机的预测价值。方法选择2012年10月~2015年10月河北省胸科医院收治进入ICU的患者268例的资料进行回顾性分析。根据患者是否撤机成功分为对照组和观察组,对照组为拔管成功,观察组为拔管失败。对比两组的一般情况、各项撤机指标。分析ΔDIVC和ΔSCVO 2对机械通气患者撤机的预测价值、ΔDIVC和ΔSCVO 2的相关性。结果在全部268例患者中,有73例撤机后再插管,对照组195例,观察组73例。观察组的改良呼吸机撤机指数、ΔDIVC、ΔSCVO 2均大于对照组(P<0.05)。利用改良呼吸机撤机指数、ΔDIVC和ΔSCVO 2对机械通气患者撤机是否能够进行预测,最佳截断值分别为21.63(分)、24.65、4.75,约登指数分别为26.06%、37.44%、34.23%。ΔDIVC和ΔSCVO 2之间呈正相关(r=0.104,P<0.05)。结论ΔDIVC和ΔSCVO 2对机械通气患者是否应该撤机具有一定的预测价值,但是在工作中,需要参考更多的指标进行全面分析后得出准确的判断。

Predictive value of inferior vena cava variability and central venous oxygen saturation change rate for mechanical ventilation patients with weaning

Objective To explore the predictive value of inferior vena cava variability(ΔDIVC)and change rate of central venous oxygen saturation(ΔSCVO 2)in mechanical ventilation patients with weaning.Methods The data of 268 patients admitted to ICU in Hebei chest hospital from October 2012 to October 2015 were analyzed retrospectively.The patients were divided into the control group and the observation group according to whether the machine was removed successfully.The control group was successful and the observation group was unsuccessful.The general situation and various indexes of the two groups were compared.The predictive value ofΔDIVC andΔSCVO 2 in patients with mechanical ventilation was analyzed.The correlation betweenΔDIVC andΔSCVO 2 was analyzed.Results Among the 268 patients,73 patients were intubated after withdrawal,195 in the control group and 73 in the observation group.The modified ventilator withdrawal index,ΔDIVC andΔSCVO 2 in the observation group were higher than those in the control group(P<0.05).The best cutoff values were 21.63(score),24.65(score),4.75,and Yoden index was 26.06%,37.44%and 34.23%,respectively.There was a positive correlation betweenΔDIVC andΔSCVO 2(r=0.104,P<0.05).ConclusionΔDIVC andΔSCVO 2 have certain predictive value on whether patients with mechanical ventilation should be withdrawn.But in the work,it is necessary to refer to more indicators for a comprehensive analysis to get an accurate judgment.