中心静脉血氧饱和度对困难脱机病人拔管失败预测价值的临床研究简

目的 探讨中心静脉血氧饱和度（ScvO2）对困难脱机病人拔管失败的预测价值.方法机械通气超过48 h的困难脱机病人,其中成功经历两步脱机策略后给予拔除气管插管的病人入选为进一步的研究对象.拔管失败定义为在48 h内需要重新插管.根据定义进一步分为拔管成功（ES）组和拔管失败（EF）组,测量病人自主呼吸试验（SBT）前1 min及后30 min的各项参数.结果 再插管率为32%.ScvO2的ROC曲线分析显示SBT开始后30 min,ScvO2下降5.4%,敏感性93%,特异性88%.结论 ScvO2是困难脱机病人拔管失败的一个早期的预测因子,下降5.4%以上可作为预测阈值.

Central venous saturation as a predictor to define reintubation in difficult-to-wean patients

Objective To evaluate the predictive value of central venous saturation to detect extubation fail- ure in difficult-to-wean patients. Methods All difficult-to-wean patients were extubated after undergoing a two-step weaning protocol. Extubation failure was defined as the need of reintubation within 48 hours. The weaning protocol e- valuated hemodynamie and ventilation parameters, arterial and venous gases during mechanical ventilation （immedi- ately before T-tube trial）, and at the 30th minutes of spontaneous breathing trial. Results The reintubation rate was 32%. The ROC curve of ScvO2 showed the level of ScvO2 decreased 5.4% 30 minutes ＇after SBT. The sensitivity was 93% , and the specificity was 88%. Conclusion Central venous saturation is an early predictor of extubatinn fail- ure.