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目的探讨血浆脑钠肽(BNP)水平对慢性阻塞性肺疾病(COPD)患者撤机的指导价值。方法行机械通气超过24h的COPD患者36例,具备撤机条件后测定开始有创机械通气时(T0)、行T管自主呼吸试验(SBT)前(T1)和SBT后(T2)的血浆BNP水平,计算T1和T2的BNP差值(ΔBNP)。绘制ROC曲线,分析血浆BNP水平对撤机结局的预测价值。结果撤机成功组19例,失败组17例。两组T0时的血浆BNP无统计学差异(P>0.05)。成功组T1和T2的BNP均低于失败组[(142.3±52.6)pg/ml vs.(462.3±129.7)pg/ml和(155.1±53.8)pg/ml vs.(544.6±142.9)pg/ml](P<0.05)。成功组ΔBNP低于失败组[(12.9±4.3)pg/ml vs.(82.3±18.9)pg/ml](P<0.01)。ΔBNP>29pg/ml预测撤机失败的灵敏度为92.9%,特异度为69.2%;T1时,BNP>139.0pg/ml预测撤机失败的灵敏度为69.2%,特异度为78.6%;T2时,BNP>157.0pg/ml预测撤机失败的灵敏度为78.6%,特异度为76.9%。结论撤机过程中,动态监测血浆BNP水平对COPD患者撤机结局有一定的预测价值。
Objective To investigate the value of plasma brain natriuretic peptide (BNP) in patients with weaning of chronic obstructive pulmonary disease (COPD). Methods Thirty-six patients with chronic obstructive pulmonary disease (COPD) with mechanical ventilation over 24 hours were enrolled in this study. Patients with mechanical ventilation (T0), pre-SBT (T1) and post-SBT (T2) The BNP difference (ΔBNP) between T1 and T2 was calculated. ROC curve was drawn, and the predictive value of plasma BNP level on weaning outcome was analyzed. Results Weaning successful group of 19 cases, failure group of 17 cases. There was no significant difference in plasma BNP between the two groups at T0 (P> 0.05). BNP in T1 and T2 of the successful group were lower than those in the failed group [(142.3 ± 52.6) pg / ml vs. (462.3 ± 129.7) pg / ml and (155.1 ± 53.8) pg / ml vs. (544.6 ± 142.9) pg / ml ] (P <0.05). The level of ΔBNP in the success group was lower than that in the failure group [(12.9 ± 4.3) pg / ml vs. (82.3 ± 18.9) pg / ml] (P <0.01). The sensitivity and predictive accuracy of BNP> 29 pg / ml for predicting weaning failure were 92.9% and 69.2%, respectively. At T1, BNP> 139.0 pg / ml had a sensitivity of 69.2% and a specificity of 78.6% > 157.0 pg / ml The sensitivity to predict weaning failure was 78.6% with a specificity of 76.9%. Conclusions During the weaning process, the dynamic monitoring of plasma BNP level has some predictive value for the weaning outcome of COPD patients.