内科

【摘要】目的探讨血浆B型脑钠肽（BNP）水平在指导慢性阻塞性肺疾病急性加重期行机械通气治疗患者选择撤机时机的价值。方法对2007～2015年在我院重症监护病房住院并行机械通气治疗的慢性阻塞性肺疾病急性加重期患者85例的临床资料进行回顾性分析。将首次撤机时血浆BNP＜100 pg/mL的患者作为观察组（45例），BNP≥100 pg/mL的患者作为对照组（40例）。比较两组患者撤机成功率，并绘制患者血浆BNP水平预测撤机结局的ROC曲线，评价预测撤机结局的效能。结果观察组患者首次成功脱机25例，再次脱机成功7例，合计成功脱机32例（71.1%）；对照组患者首次成功脱机12例，再次脱机成功3例，合计成功脱机15例（37.5%），观察组患者脱机成功率显著高于对照组，差异具有统计学意义（P＜0.05）。患者BNP水平预测撤机结局的ROC曲线下面积AUC为（0.882±0.035），95%CI为（0.813～0. 951)；以最靠左上角的截断点为最佳临床预测界点，其预测撤机成败的截断值为176.50 pg/mL ， Youden指数为 0.62, 敏感性为66%，特异性为96. 1%（P＜0.05）。结论监测血浆BNP水平对行机械通气治疗的慢性阻塞性肺疾病急性加重期患者选择撤机时机具有一定的指导价值。

【Abstract】ObjectiveTo study the guiding value of plasma BNP on invasive mechanical ventilation weaning time of patients with COPD in acute exacerbation (AECOPD). MethodsThe clinical data of 85 patients with AECOPD who required mechanical ventilation admitted to ICU in our hospital from 2007 to 2015 were analyzed retrospectively. The patients were divided into observation group (45 cases, BNP＜100 pg/mL) and control group (40 cases, BNP≥100 pg/mL ) according to the level of plasma BNP at first time of invasive mechanical ventilation weaning. The successful rate of invasive mechanical ventilation weaning were compared between two groups, and the ROC curve was drawn to analyze the predictive value of the level of plasma BNP on weaning results. ResultsThere were 25 cases in the observation group had successful weaning at the first time, and 7 cases at the second time, the total successful rate of invasive mechanical ventilation weaning was 71.1% (32 cases); these data in the control group were 12cases, 3 cases, and 37.5% (15 cases), respectively, the total successful rate of invasive mechanical ventilation weaning in the observation group was significantly higher than that of the control group (P＜0.05). The AUC of the level of BNP in predicting weaning was（0.882±0.035）, 95% CI was (0.813～0.951); take the truncation point in the upper left corner as the best clinical prediction point, the cutoff value of the level of BNP in predicting successfailure weaning was 176.50 pg/mL, Youden index was 0.62, sensitivity was 66%, specificity was 96.1% (P＜0.05). ConclusionsThe level of plasma BNP has a guiding value on predicting weaning results of patients with AECOPD.