摘要
目的改良ROX指数联合心率变异性对机械通气脓毒症患者延迟撤机的预测价值。方法以160例行机械通气治疗的脓毒症患者为研究对象,均于2022年10月-2024年10月在本院就诊。将研究对象根据是否发生延迟撤机分为延迟撤机组和正常撤机组,收集研究对象临床资料、改良ROX指数、心率变异性指标。筛选影响机械通气脓毒症患者延迟撤机的危险因素,绘制受试者工作特征(ROC)曲线分析改良动态ROX指数联合心率变异性对机械通气脓毒症患者延迟撤机的预测价值。结果延迟撤机组APACHEⅡ评分(18.75±3.41)分高于正常撤机组(17.21±3.12)分(t=2.810,P=0.006)。与正常撤机组相比,延迟撤机组SBT试验后30 min改良ROX指数(6.15±1.89)、SDNN(94.36±6.54)ms、LF(5.24±1.68)ms、LF/HF(0.350±0.08)水平更低(t=6.439、13.992、12.938、13.426,P<0.05)。Logistic回归分析结果显示高SBT试验后30 min改良ROX指数(OR=0.331)、SDNN(OR=0.216)、LF(OR=0.260)、LF/HF(OR=0.223)水平均是影响机械通气脓毒症患者延迟撤机的保护因素(P<0.05)。ROC曲线显示,SBT试验后30 min改良ROX指数、SDNN、LF、LF/HF水平及上述指标联合预测机械通气脓毒症患者延迟撤机的ROC曲线下面积(AUC)分别为0.776、0.859、0.821、0.849、0.889(P<0.05)。结论SBT试验后30 min改良ROX指数、心率变异性与机械通气脓毒症患者延迟撤机关系密切,且联合检测的预测价值更高。
Objective To investigate the predictive value of the modified ROX index combined with heart rate variability for delayed weaning in mechanically ventilated sepsis patients.Methods A total of 160 patients with sepsis who underwent mechanical ventilation were enrolled in this study,all of whom were treated in our hospital from October 2022 to October 2024.The subjects were divided into two groups based on whether they experienced delayed weaning:the delayed weaning group and the normal weaning group.Their clinical data,modified ROX index,and heart rate variability indicators were collected.The risk factors associated with delayed weaning in mechanically ventilated sepsis patients were identified,and a predictive model was constructed by the modified dynamic ROX index combined with heart rate variability.Receiver operating characteristic(ROC)curve analysis was performed to evaluate the predictive value of this combined model for delayed weaning in mechanically ventilated sepsis patients.Results The score of APACHEⅡ(18.75±3.41)in the delayed group was higher than that in the normal group(17.21±3.12)(t=2.810,P=0.006).Compared with the normal group,the levels of improved ROX index(6.15±1.89),SDNN(94.36±6.54)ms,LF(5.24±1.68)ms,and LF/HF(0.35.±0.08)in the delayed group 30 minuets after SBT test were lower(t=6.439,13.992,12.938,13.426,P<0.05).The results of logistic regression analysis showed that the levels of min modified ROX index(OR=0.331),SDNN(OR=0.216),LF(OR=0.260),and LF/HF(OR=0.223)were all protective factors affecting delayed weaning in patients with sepsis undergoing mechanical ventilation 30 minuets after high SBT test(P<0.05).The ROC curve analysis indicated that the AUC value for predicting delayed weaning by modified ROX index,SDNN,LF,LF/HF,and the combination of these indicators were 0.776,0.859,0.821,0.849,and 0.889,respectively(P<0.05).Conclusion Improved ROX index and heart rate variability 30 min after SBT test are closely related to delayed withdrawal mechanism of patients with mechanical ventilation sepsis,and its combined detection has higher predictive value.
作者
张超青
卢仲谦
李兴
何磊
许彬彬
吴艳
邓义军
ZHANG Chaoqing;LU Zhongqian;LI Xing;HE Lei;XU Binbin;WU Yan;DENG Yijun(The First People’s Hospital of Yancheng,the First Hospital Affiliated to the School of Medicine of Nanjing University,Yancheng,Jiangsu 224000,China)
出处
《临床肺科杂志》
2025年第8期1164-1169,共6页
Journal of Clinical Pulmonary Medicine
基金
盐城市科技项目(YK2023059)。
关键词
改良ROX指数
心率变异性
机械通气
脓毒症
延迟撤机
improved ROX index
heart rate variability
mechanical ventilation
sepsis
delayed withdrawal
作者简介
通信作者:邓义军,E-mail:15366103007@qq.com。
