SBT联合BNP监测对COPD患者拔管结局的预测价值

目的探讨自主呼吸试验(SBT)联合脑钠肽(BNP)预测慢性阻塞性肺疾病(COPD)患者拔管结局价值.方法选择2016年1月至2018年12月广东同江医院重症监护室收治的需要行有创机械通气的COPD呼吸衰竭患者80例,根据最终成功拔管与否分为拔管成功组和拔管失败组.分别记录SBT试验前及通过SBT试验2h后患者BNP、血气分析结果,比较SBT前后BNP差值△BNP和△BNP的受试者工作特征曲线及曲线下面积.结果(1)SBT前,2组BNP水平差异无统计学意义(t=0.040,P>0.05),SBT后,拔管失败组BNP水平高于拔管成功组(t=23.458,P<0.05).(2)SBT前,2组pH、动脉血二氧化碳分压、动脉血氧分压差异均无统计学意义(t=1.030、0.481、0.585,P值均>0.05),SBT后,拔管失败组pH、动脉血氧分压低于拔管成功组(t=5.678、2.012,P值均<0.05),动脉血二氧化碳分压高于拔管成功组(t=5.098,P<0.05).(3)△BNP AUC大于SBT前BNP和SBT后BNP,△BNP的cut-off值为45 ng/L,特异度为95.66%,敏感度为83.32%,预测脱机后拔管失败准确率为93.11%.结论对于COPD合并心功能不全患者,达到撤机标准后,在进行SBT基础上评价SBT前后△BNP水平可有效预测COPD合并心功能不全患者撤机拔管成功率,可在临床广泛推广使用.

Predictive value of SBT combined with BNP monitoring in extuhation outcome of COPD patients

Objective To explore the value of spontaneous breathing trials(SBT)combined with brain natriuretic peptide(BNP)in predicting extubation outcome in chronic obstructive pulmonary disease(COPD)patients.Methods A total of 80 patients with COPD and respiratory failure who underwent invasive mechanical ventilation and were admitted to intensive care unit in Guangdong Tongjiang Hospital from January 2016 to December 2018 were enrolled.According to ultimate extubation results,they were divided into successful extubation group and unsuccessful extubation group.BNP and blood gas analysis results were recorded before SBT test and at 2 h after SBT test.The difference value of BNP(△BNP)and receiver operating characteristic curves area under curves(AUC)of△BNP before and after SBT were compared.Results(1)There was no significant difference in BNP before SBT between the two groups(t=0.040,P>0.05).After SBT,BNP in unsuccessful extubation group was higher than that in successful extubation group(t=23.458,P<0.05).(2)Before SBT,there was no significant difference in pH,PaCO2 or PaO2 between the two groups(t=1.030,0.481,0.585,all P>0.05).After SBT,pH and PaO2 of unsuccessful extubation group were lower than those of successful extubation group(t=5.678,2.012,both P<0.05),while PaCO2 was higher than that of successful extubation group(t=5.098,P<0.05).(3)AUC of ABNP was higher than that of BNP before and after SBT.The Cutoff,specificity and sensitivity of ABNP were 45 n g/L,95.66% and 83.32%.The accuracy of predicting extubation failure after weaning was 93.11%.Conclusions For patients with COPD and cardiac insufficiency,after reaching the withdrawal criteria,evaluating ABNP level before and after SBT based on conducting SBT can effectively predict success rate of weaning and extubation of patients with COPD and cardiac insufficiency,and can be widely applied in clinical practice.