自主呼吸试验联合B型脑钠肽浓度预测撤机成功率的价值

目的评价自主呼吸试验联合试验前后B型脑钠肽（BNP）变化情况是否能提高撤机成功率。方法前瞻性队列研究,收集2008年7月至2010年12月安徽省立医院83例ICU住院需机械通气患者自主呼吸试验前30 min及90 min自主呼吸试验结束时血浆BNP数据。依撤机结局将患者分为成功组和失败组。正态分布数据采用t检验,非正态分布数据采用非参数独立样本及配对检验。用受试者工作特征（ROC）曲线评价自主呼吸试验前后BNP差值预测撤机成功率的价值。结果 83例患者中,撤机失败13例（15.7%）。6例自主呼吸试验成功而撤机失败（占入选患者的7.2%,占撤机失败患者的46.2%）。自主呼吸试验结束时BNP水平显著高于试验前。撤机成功组自主呼吸试验结束时BNP水平及上升幅度均明显小于撤机失败组（P〈0.001）。自主呼吸试验前后BNP差值预测撤机失败的ROC曲线下面积为0.94±0.03（P〈0.001）,以BNP上升123 pg/mL为拐点,预测撤机成功的敏感性为92.3%,特异性为91.4%。结论自主试验前后BNP的变化可作为撤机结局的一种预测指标,联合自主呼吸试验能提高撤机的成功率。

B-Type Natriuretic Peptide Improve Weaning Outcome Predicted by Spontaneous Breathing Trial

Objective To determine whether B-type natriuretic peptide(BNP) levels combined with spontaneous breathing trial(SBT) could improve the weaning outcome.Methods Eighty-three patients who were ready to undergo a 90-minute weaning trial(low-pressure support level) were enrolled.Weaning was considered to be successful if the patient passed the trial and sustained spontaneous breathing for more than 48 h after extubation.Plasma BNP was measured just before and at the end of the trial.All patients were divided int...