探讨浅快呼吸指数指导COPD患者撤机的临床价值

目的评价浅快呼吸指数（rapid-shallow-breathing index,RSBI）作为COPD患者撤机的临床价值。方法呼吸重症监护病房的20例机械通气的COPD患者,均通过了1h的自主呼吸实验（spontaneous breathing trial,SBT）。记录两个时期的RS-BI：SBT前、SBT1h。同时记录年龄、性别、APACHEⅡ（acute physiology and chronic health evaluationⅡ）评分、撤机前的动脉血气分析。结果 16例COPD患者成功撤机,4例患者撤机失败。在成功和失败两组间年龄、性别、APACHEⅡ评分无明显差异（P〉0.05）,PaCO2（partial pressure of carbon dioxide in arterial blood）有明显差异（P〈0.05）。以RSBI≤105bpm/L为标准预测撤机成功的灵敏度和特异度分别为：SBT前RSBI93.8%、10%;SBT1h的RSBI93.8%、45.5%。SBT1h的RSBI与PaCO2联合预测撤机成功的灵敏度为89.5%,特异度为78%。结论 SBT1h的RSBI预测COPD患者成功撤机的准确性高于SBT前,其与PaCO2联合评价将提高预测撤机成功的准确性。

Evaluating rapid-shallow-breathing index as a weaning predictor in weaning for the patients with chronic obstructive pulmonary disease

Objective To evaluate the significance of rapid-shallow-breathing index（RSBI） as a weaning predictor in mechanical ventilation patients with chronic obstructive pulmonary disease（COPD）.Methods Twenty mechanical ventilation patients with COPD in our respiratory intensive care unit tolerated a one-hour spontaneous breathing trial（SBT）.before the SBT,one hour after the SBT respiratory parameters were recorded,and sex,age,acute physiology,chronic health evaluationⅡ（APACHEⅡ） score and the value of arterial blood gases analysis just before weaning were also recorded.Results Sixteen cases were successfully extubated,and four cases required reintubation.Both groups were similar in age,sex and APACHE Ⅱ score（P〉 0.05）.Partial pressure of carbon dioxide in arterial blood（PaCO2） measured before weaning was significantly different between successful extubations and failed extubations（P〈 0.05）.Using an RSBI≤105 bpm/L as the threshold value for predicting successful weaning,the diagnostic sensitivity and specificity were respecting as follows：RSBI before SBT 93.8% and 10% ;RSBI at one-hour after SBT 93.8% and 45.5%.Detected by combining RSBI at one-hour after SBT and PaCO2,the diagnostic sensitivity and specificity for predicting successful weaning were 89.5% and 78%.Conclusion RSBI measured at one-hour after SBT is superior to that measured before SBT in predicting weaning outcome in COPD patients.The joint detection of RSBI at one-hour after SBT and PaCO2 will improve the accuracy of predicting successful weaning in COPD.