血浆脑钠肽水平对COPD机械通气患者撤机结局的预测价值-现代医学

血浆脑钠肽水平对COPD机械通气患者撤机结局的预测价值

单位：海南省农垦总医院

分类号：R563

出版年·卷·期（页码）：2014·42·第五期（494-497）

摘要：

目的：评价血浆B 型脑钠肽( B-type natriuretic peptide，BNP)水平对慢性阻塞性肺疾病(Chronic obstructive pulmonary disease，COPD) 机械通气患者撤机结局的预测价值。方法：回顾性分析2008年1月至2013年6月在我院ICU住院达到撤机标准并行撤机的COPD机械通气患者。根据撤机结局分为撤机成功组和失败组，以成组t检验及x2检验比较两组间年龄、性别、pH值、PaO2、PaCO2及撤机前血浆BNP水平；绘制ROC曲线，评价撤机前血浆BNP水平对撤机结局的预测价值。结果：共入选158例患者，成功组108例，失败组50例。成功组年龄低于失败组[(65.8士7.3)vs(73.4±7.6)， P=0.033]，两组性别、pH、PaO2、PaCO2差异无统计学意义(P>0.05)。失败组撤机前血浆BNP水平明显高于成功组[Lg10BNP (2.48±0.26 )vs(2.19±0.31)， P= .000]；撤机前血浆BNP水平预测撤机失败的ROC曲线下面积为0.876±0.031，(95％CI 0.815～0.937)，其预测撤机失败的截点值为224.5pg/ml。此值下的Youden指数为0.66，正确百分率为81.6％，敏感性为80％，特异性为86.1％，阳性似然比5.76，阴性似然比0.232，Kappa值为0.71。结论：撤机前血浆BNP水平对COPD机械通气患者撤机结局有一定的预测价值，可作为撤机筛杳指标之一。

0bjective To evaluate the value of serum B-type natriuretic peptide(BNP ) in predicting the weaning outcome of mechanical ventilation patients with Chronic obstructive pulmonary disease(COPD)．Methods The data of mechanical ventilation patients with COPD who met the clinical weaning criteria in the intensive care unit（ICU） from January 2008 to June 2013，were retrospective reviewed．All patients were divided into the success group and the failure group as per the outcomes of weaning．Age，gender，pH，PaO2，PaCO2 and serum BNP recorded before weaning were compared between two groups with Student t-test and Chi-square test．The ROC curve was drawn to evaluate the value of serum BNP in predicting the outcome of weaning．Results A total of 158 patients were eligible for inclusion in the study，and there were 108 cases in the success group and 50 cases in the failure group．Compared with the failure group，The patients of the success group was yonger (65.8士7.3 vs 73.4±7.6， P=0.033)，and no difference in gender，pH，PaO2 and PaCO2 (P>0.05)．The serum BNP levels of the failure group were significantly higher than those of the success group (Lg10BNP 2.48±0.26 vs 2.19±0.31)．The area under cure(AUC) of the ROC cure of serum BNP to predict the failure of weaning was 0.876±0.031 (95％CI 0.815～0.937)，when the cut-off level of serum BNP was 224.5pg/ml．And，this serum BNP level had a followed predictive efficiency in weaning outcome (Youden’s index：0.66，accuracy：81.6％，sensitivity：80％，specificity：86.1％，positive likelihood ratio：5.76，negative likelihood ratio：0.232，Kappa value：0.71)．Conclusion The levels of serum BNP before weaning have predictive value in predicting the weaning outcome of mechanical ventilation patients with COPD，and it may be used as one of the screening indicators for weaning．

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