| 毛佳斌,孙培英.血清25-(OH)D3水平对慢性阻塞性肺病合并呼吸衰竭患者机械通气撤机失败的影响[J].浙江中西医结合杂志,2016,26(7): |
| 血清25-(OH)D3水平对慢性阻塞性肺病合并呼吸衰竭患者机械通气撤机失败的影响 |
| Influence of serum 25(OH) D3 level on unsuccessful weaning from mechanical ventilation in patients with respiratory failure due to chronic obstructive pulmonary disease |
| 投稿时间：2015-11-02 修订日期：2016-04-15 |
| DOI： |
| 中文关键词: 慢性阻塞性肺病 呼吸衰竭 25-羟维生素D3 机械通气 撤机 |
| 英文关键词:Chronic obstructive pulmonary disease Respiratory failure. 25-hydroxy vitamin D3 Mechanical ventilation Weaning |
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| 中文摘要: |
| 目的 探讨血清25-(OH)D3水平对慢性阻塞性肺病(COPD)合并呼吸衰竭患者机械通气撤机失败的影响。 方法 选取2012年6月至2014年8月我院收治的126例COPD合并呼吸衰竭并接受机械通气患者为研究对象,按照撤机结局患者分为撤机成功组(n=86例)和撤机失败组(n=36例),记录两组患者入ICU时一般临床资料、急性病生理学和长期健康评价(APACHE)Ⅱ评分、机械通气时间及住ICU时间及各项生理指标,检测入ICU时血清25-羟维生素D3[25-(OH) D3]、血浆BNP水平、血常规、血生化及相关实验室指标,比较各组间相关指标的差异。 结果 与撤机成功组比较,撤机失败组血清25-(OH) D3、血清白蛋白水平明显降低(P＜0.05)；心功能不全病史比例较高(P＜0.05)、机械通气时间及住ICU时间较长,血浆BNP、APACHEⅡ评分及呼吸机相关性肺炎(VAP)发生率较高(P＜0.05)；按照患者血清25-(OH) D3水平的中位数(本研究中25.7μg/L为中位数)分两组,与25-(OH) D3≥25.7μg/L组比较,25-(OH) D3＜25.7μg/L组的血浆BNP、心不功能不全病史比例、VAP比例及撤机失败比例高于(P＜0.05),机械通气时间及住ICU时间亦较长(P＜0.05)；多因素Logistic回归分析显示: 心不功能不全病史、血浆BNP、APACHEⅡ评分、发生VAP及低血清25-(OH) D3水平是撤机失败的高危因素。对血清25-(OH)D3水平绘制受试者工作特征曲线(ROC曲线),血清25-(OH)D3水平曲线下面积为0.762(95%CI=0.683～0.835,P<0.05),预测患者撤机失败的最佳截断值为23.2μg/L (敏感度64.4%,特异度79.9%)。 结论 血清低水平25-(OH) D3与COPD合并呼吸衰竭行机械通气患者的撤机结局密切相关,对撤机失败具有一定的预测价值,可作为临床撤机筛查的指标之一。 |
| 英文摘要: |
| Abstract: Objective To investigate the effects of serum 25(OH)D3 level on unsuccessful weaning from mechanical ventilation in patients with respiratory failure due to chronic obstructive pulmonary disease (COPD). Methods 126 cases of mechanical ventilated COPD patients with type 11 respiratory failure were enrolled from June 2012 to August 2014 in our hospital, all patients were divided into success group (n=86 cases) and failure group (n=36 cases) based on their weaning outcome; general clinical data of two groups, acute physiology and chronic health evaluation (APACHE) Ⅱ score, time of mechanical ventilation and duration of ICU stay recoded, and serum 25(OH)D3, plasma BNP, routine blood test, blood biochemical examination were detected. Results Compared with success group, serum 25(OH) D3, serum albumin levels of failure group significantly decreased (P<0.05); ratio of patients with cardiac insufficiency history was higher (P<0.05), time of mechanical ventilation and duration of ICU stay were longer, plasma BNP, APACHE Ⅱ score and incidence of ventilator associated pneumonia (VAP) were higher (P< 0.05); according to patients' median of serum 25(OH)D3 level (the median was 25.7μg/L in this study) all cases divided into two groups, compared with 25-(OH)D3≥25.7μg/L group, ratio of patients with cardiac insufficiency history was higher in 25(OH)D3<25.7 group (P<0.05), time of mechanical ventilation and duration of ICU stay were longer, plasma BNP, APACHE Ⅱ score and incidence of ventilator associated pneumonia (VAP) were higher (P<0.05); multivariable Logistic regression analysis showed that cardiac insufficiency history, plasma BNP, APACHE Ⅱ score, VAP and low serum 25 (OH)D3 level were high risk factors of unsuccessful weaning from mechanical ventilation; receiver-operating characteristic curve (ROC curve) of serum 25 (OH)D3 was draw, its area under curve was 0.762 (95% CI=0.683~0.835, P<0.05), the best predict cutoff value was 23.2μg/L (sensitivity was 64.4%, specificity was 79.9%). Conclusion Low serum 25 (OH)D3 level is closely related to their weaning outcome of these cases, and has certain prediction value in predicting weaning from ventilation, it can be used as indicators of clinical screening. |
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