|本期目录/Table of Contents|

[1]朱志伦,王小忠.呼吸衰竭无创通气失败风险的RSBI预测分析[J].中华肺部疾病杂志,2023,(06):833-836.[doi:10.3877/cma.j.issn.1674-6902.2023.06.019]
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呼吸衰竭无创通气失败风险的RSBI预测分析(PDF)

《中华肺部疾病杂志》[ISSN:1006-6977/CN:61-1281/TN]

卷:
期数:
2023年06期
页码:
833-836
栏目:
临床研究
出版日期:
2023-12-20

文章信息/Info

Title:
-
作者:
朱志伦; 王小忠
215026 苏州,苏州大学附属第二医院急重症医学科
Author(s):
-
关键词:
无创通气;  急性呼吸衰竭;  浅快呼吸指数;  决策曲线分析;  预测价值
Keywords:
-
分类号:
R563
DOI:
10.3877/cma.j.issn.1674-6902.2023.06.019
摘要:
目的 分析浅快呼吸指数(rapid shallow breath index, RSBI)动态变化预测呼吸衰竭无创通气不佳的风险及临床意义。 方法 选取2021年4月至2023年1月我院收治的63例呼吸衰竭患者为对象,无创通气成功42例为对照组,通气不佳21例为观察组,收集临床资料、无创通气前、通气30 min后RSBI及通气前后RSBI差,采用多因素Logistic回归分析呼吸衰竭无创通气不佳的因素,构建预测模型,采用ROC曲线、决策曲线分析预测。 结果 观察组死亡8例(38.09%),对照组死亡6例(14.28%)(P<0.05); 观察组心率(115.26±14.02)次/min,对照组心率(106.26±13.51)次/min,P<0.05; 观察组pH(7.37±0.09),对照组pH(7.43±0.10)(P<0.05)。观察组无创通气RSBI值(106.26±14.55; 91.21±10.22)高于对照组(85.59±16.59; 57.23±9.16),通气RSBI差变化(17.34±3.69)低于对照组(27.95±5.47)(P<0.05); 多因素Logistic回归分析显示年龄(OR=1.256)、通气前RSBI(OR=1.093)、30 min后RSBI(OR=1.140)及通气前后RSBI差(OR=0.715)是呼吸衰竭无创通气不佳的危险因素(P<0.05); ROC曲线显示年龄、通气前RSBI、30 min后RSBI、通气RSBI差等单项及联合指标预测模型对呼吸衰竭无创通气不佳发生风险具有统计学意义(P<0.05),联合预测模型AUC为0.975,敏感性97.14,特异性91.18,高于单项指标预测; 决策曲线分析显示联合年龄和RSBI动态水平变化的呼吸衰竭无创通气不佳预测模型阈值概率5.32%～39.00%。结论 RSBI动态水平变化可预测呼吸衰竭无创通气不佳风险,构建的无创通气不佳风险模型具有临床参考意义。
Abstract:
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参考文献/References:

1 Vega ML, Pisani L. Nasal high flow oxygen in acute respiratory failure[J]. Pulmonology, 2021, 27(3): 240-247.
2 Comellini V, Pacilli AMG, Nava S. Benefits of non-invasive ventilation in acute hypercapnic respiratory failure[J]. Respirology, 2019, 24(4): 308-317.
3 Hill NS, Spoletini G, Schumaker G, et al. Noninvasive ventilatory support for acute hypercapnic respiratory failure[J]. Respir Care, 2019, 64(6): 647-657.
4 单梦田, 兰 超, 陈荣昌, 等. 头罩与面罩无创通气在急性呼吸衰竭中的随机对照研究[J]. 中华急诊医学杂志, 2019, 28(8): 1010-1016.
5 Domenico Luca Grieco, Luca S Menga, Melania Cesarano, et al. Effect of Helmet noninvasive ventilation vs high-flow nasal oxygen on days free of respiratory support in patients with COVID-19 and moderate to severe hypoxemic respiratory failure: The HENIVOT randomized clinical trial[J]. JAMA, 2021, 325(17): 1731-1743.
6 Alexandre Demoule, Sylvie Chevret, Annalisa Carlucci, et al. Changing use of noninvasive ventilation in critically ill patients: trends over 15 years in francophone countries[J]. Intensive Care Med, 2016, 42(1): 82-92.
7 Istvan Ruzsics, Peter Matrai, Peter Hegyi, et al. Noninvasive ventilation improves the outcome in patients with pneumonia-associated respiratory failure: Systematic review and meta-analysis[J]. J Infect Public Health, 2022, 15(3): 349-359.
8 Liang YR, Lan CC, Su WL, et al. Factors and outcomes associated with failed noninvasive positive pressure ventilation in patients with acute respiratory failure[J]. Int J Gen Med, 2022, 15: 7189-7199.
9 刘 刚, 李 琦. 无创正压通气:优化设置模式与参数应用及管理[J/CD]. 中华肺部疾病杂志(电子版), 2022, 15(6): 916-919.
10 Saravanan R, Nivedita K, Karthik K, et al. Role of diaphragm ultrasound in weaning mechanically ventilated patients: A prospective observational study[J]. Indian J Anaesth, 2022, 66(8): 591-598.
11 Vatsal Trivedi, Dipayan Chaudhuri, Rehman Jinah, et al. The usefulness of the rapid shallow breathing index in predicting successful extubation: A systematic review and Meta-analysis[J]. Chest, 2022, 161(1): 97-111.
12 Berg KM, Lang GR, Salciccioli JD, et al. The rapid shallow breathing index as a predictor of failure of noninvasive ventilation for patients with acute respiratory failure[J]. Respir Care, 2012, 57(10): 1548-1554.
13 Bram Rochwerg, Laurent Brochard, Mark W Elliott, et al. Official ERS/ATS clinical practice guidelines: noninvasive ventilation for acute respiratory failure[J]. Eur Respir J, 2017, 50(2): 1602426.
14 Yu J, Lee MR, Chen CT, et al. Predictors of successful weaning from noninvasive ventilation in patients with acute exacerbation of chronic obstructive pulmonary disease: A single-center retrospective cohort study[J]. Lung, 2021, 199(5): 457-466.
15 杨静翔, 秦光梅, 罗 虎. 无创通气治疗慢性阻塞性肺疾病急性加重期合并Ⅱ型呼吸衰竭临床分析[J/CD]. 中华肺部疾病杂志(电子版), 2021, 14(3): 272-276.
16 Istvan Ruzsics, Peter Matrai, Peter Hegyi, et al. Noninvasive ventilation improves the outcome in patients with pneumonia-associated respiratory failure: Systematic review and meta-analysis[J]. J Infect Public Health, 2022, 15(3): 349-359.
17 Wang H, Zhao QY, Luo JC, et al. Early prediction of noninvasive ventilation failure after extubation: development and validation of a machine-learning model[J]. BMC Pulm Med, 2022, 22(1): 304.
18 刘春桃, 付 敏, 陈 希, 等. 无创通气失败风险预测模型的研究进展[J]. 中国呼吸与危重监护杂志, 2022, 21(9): 678-684.
19 Van Gemert JP, Brijkr F. Intubation after noninvasive ventilation failure in chronic obstructive pulmonary disease: associated factors at emergency department presentation[J]. Eur J Emerg Med, 2015, 22(1): 67-69.
20 Song J, Qian Z, Zhang H, et al. Diaphragmatic ultrasonography-based rapid shallow breathing index for predicting weaning outcome during a pressure support ventilation spontaneous breathing trial[J]. BMC Pulm Med, 2022, 22(1): 337.
21 Lokesh Kumar Lalwani, Manjunath B Govindagoudar, Pawan Kumar Singh, et al. The role of diaphragmatic thickness measurement in weaning prediction and its comparison with rapid shallow breathing index: a single-center experience[J]. Acute Crit Care, 2022, 37(3): 347-354.
22 Lin MS, Guo HR, Huang MH, et al. Predictors of successful noninvasive ventilation treatment for patients suffering acute respiratory failure[J]. J Chin Med Assoc, 2008, 71(8): 392-398.
23 蒲晓伟, 梅 花. 慢阻肺急性加重期无创机械通气失败的危险因素[J]. 现代仪器与医疗, 2019, 25(3): 48-51.
24 Acar H, Yamanoglu A. Rapid shallow breathing index as a predictor for intubation and mortality in acute respiratory failure[J]. Respir Care, 2022, 67(5): 562-571.
25 李 录, 方保民. 急性高碳酸血症呼吸衰竭老年患者无创通气治疗失败的相关因素分析[J]. 中华老年医学杂志, 2022, 41(4): 423-427.
26 Hassan Soleimanpour, Ali Taghizadieh, Rasoul Salimi, et al. Rapid shallow breathing index survey, a predictor of non-invasive ventilation necessity in patients with chronic obstructive pulmonary disease exacerbation: An analytical descriptive prospective study[J]. Iran Red Crescent Med J, 2014, 16(2): e13326.
27 Yoshida Y, Takeda S, Akada S, et al. Factors predicting successful noninvasive ventilation in acute lung injury[J]. J Anesth, 2008, 22(3): 201-206.
28 Sprooten RTM, Rohde GGU, Janssen MTHF, et al. Predictors for long-term mortality in COPD patients requiring non-invasive positive pressure ventilation for the treatment of acute respiratory failure[J]. Clin Respir J, 2020, 14(12): 1144-1152.
29 高胜浩, 李琳璨, 张晓菊, 等. 有创-无创机械通气降级治疗策略在气管切开呼吸机依赖患者中的应用效果研究[J]. 中国全科医学, 2021, 24(5): 571-576.
30 Doaa M Magdy, Ahmed Metwally. Effect of high-flow nasal cannula versus non-invasive ventilation in preventing re-intubation in high-risk chronic obstructive pulmonary disease patients: A randomised controlled trial[J]. Lung India, 2023, 40(4): 312-320.

备注/Memo

备注/Memo:
基金项目: 江苏省卫生健康委科研课题(BJ209845)
通信作者: 王小忠, Email: diudiuxiaozhong@sina.com
更新日期/Last Update: 2023-12-20