| 摘要: |
| 目的 研究下腔静脉变异度对心功能不全患者困难撤机的预测价值。方法 回顾性研究2014年1月-2015年12月苏州大学附属第一医院重症医学科行机械通气的心功能不全患者。对通过撤机前筛查的患者行自主呼吸试验(SBT)30分钟,按照SBT结果分为成功撤机组和困难撤机组。记录两组患者SBT过程中的下腔静脉变异度(△DIVC)、呼吸浅快指数(RBSI)及一般临床指标。比较成功撤机组和困难撤机组患者上述指标的统计学差异,采用受试者工作曲线(ROC)分别评价下腔静脉变异度和呼吸浅快指数对心功能不全患者困难撤机的预测价值。结果 本研究共纳入99例患者,其中成功撤机组59例,困难撤机组40例,成功撤机组与困难撤机组患者的一般情况,包括年龄、急性生理学与慢性健康状况评分II(APACHE II)、生命体征、血气指标等均无统计学差异(p＞0.05)。成功撤机组△DIVC(0.28±0.07)%vs. (0.19±0.04)%明显大于困难撤机组患者(p<0.05)。△DIVC预测心功能不全患者困难撤机的ROC曲线下面积为0.839(95%CI：0.752-0.925),以△DIVC≤0.25为截点预测心功能不全患者困难撤机的敏感度为69.5%,特异度为94.7%。RBSI预测心功能不全患者困难撤机的ROC曲线下面积为0.816(95%CI：0.727-0.905),以RBSI＞105为截点预测心功能不全患者困难撤机的敏感度为91.7%,特异度为35.2%。结论 超声下下腔静脉变异度的监测对心功能不全患者困难撤机的预测具有一定的指导价值。 |
| 关键词: 超声 心功能不全 下降静脉变异度 困难撤机 重症 预测价值 |
| DOI： |
| 投稿时间：2016-08-05修订日期：2016-09-11 |
| 基金项目:国家自然科学基金项目（面上项目，重点项目，重大项目） |
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| The predictive value of the variation of inferior vena cava for difficult weaning with cardiac dysfuncion |
| buzhang,xushan |
| () |
| Abstract: |
| Objective To evaluate the predictive value of the variation of inferior vena cava for difficult weaning patients with cardiac dysfuncion.Methods Ninety-nine patients with cardiac dysfuncion were enrolled for prospective study.All patients were expected to weaned when they passed the screening from January 2014 to December 2015.Patients received SBT under PSV for 1 h.At the end of the SBT, the inferior vena cava was visualized under B ultrasound probe.The patients who passed the SBT and no need for either reintubation or noninvasive ventilation within 48 hours were include into successful weaning group, the others were included into difficult weaning group.Result Of the 99 patients admitted, 59 patients were successful weaning,40 patients were difficult weaning.A significant differences in the inferior vena cava between successful weaning group and difficult weaning group.It’s AUC to predict difficult weaning was 0.839,with a sensitivity of 69.5% and a specificity of 94.7%.There was a sensitivity of 91.7% and a specificity of 35.2% for determining difficult weaning when RBSI was ＞105,It’s AUC was 0.816 for RBSI.Conclusion The assessment of the variation of inferior vena cava using ultrasound was helpful to predict difficult weaning for patients with cardiac dysfuncion. |
| Key words: Ultrasound Cardiac dysfuncion Variation of inferior vena cava Difficult weaning Critical ill Predictive value |
