切换至 "中华医学电子期刊资源库"

第五届中国出版政府奖音像电子网络出版物奖提名奖

中国科技核心期刊

中国科学引文数据库(CSCD)来源期刊

中华重症医学电子杂志 doi: 10.3877/cma.j.issn.2096-1537.2025.03.26-0007

临床研究

高原地区机械通气患者脱机失败预测模型研究
程莉1, 王斌2,(), 蔺国英1, 杜安琪2, 次央1, 李茜玮1, 赵慧颖2,()   
  1. 1. 850000 拉萨,西藏自治区人民医院重症医学科
    2. 100004 北京,北京大学人民医院重症医学科
  • 收稿日期:2024-07-12
  • 通信作者: 王斌, 赵慧颖
  • 基金资助:
    西藏自治区自然科学基金组团式援藏医学项目[XZ2022ZR-ZY04(Z)]北京市临床重点专科卓越项目(2021)

Study on prediction model of weaning failure of mechanical ventilation patients in plateau area

Li Cheng1, Bin Wang2,(), Guoying Lin1, Anqi Du2, Qianwei Li1, Huiying Zhao2,()   

  1. 1. Department of Intensive Care Medicine, Xizang Autonomous Region People's Hospital, Lhasa 850000, China
    2. Department of Critical Care Medicine, Peking University People's Hospital, Beijing 100004, China
  • Received:2024-07-12
  • Corresponding author: Bin Wang, Huiying Zhao
引用本文:

程莉, 王斌, 蔺国英, 杜安琪, 次央, 李茜玮, 赵慧颖. 高原地区机械通气患者脱机失败预测模型研究[J/OL]. 中华重症医学电子杂志, doi: 10.3877/cma.j.issn.2096-1537.2025.03.26-0007.

Li Cheng, Bin Wang, Guoying Lin, Anqi Du, Qianwei Li, Huiying Zhao. Study on prediction model of weaning failure of mechanical ventilation patients in plateau area[J/OL]. Chinese Journal of Critical Care & Intensive Care Medicine(Electronic Edition), doi: 10.3877/cma.j.issn.2096-1537.2025.03.26-0007.

目的

构建列线图预测模型针对高原地区机械通气患者脱机失败进行预测。

方法

选择2023年1月1日至12月31日西藏自治区人民医院ICU收治的需要有创机械通气的患者255例。根据目前临床上实施的机械通气及脱机操作对患者进行常规治疗,并依据是否脱机成功,将患者分为脱机成功组(184例)和脱机失败组(71例)。收集2组患者的人口学特征、合并症、生命体征、器官功能等临床指标,并进行单因素比较分析,然后将统计学有差异的指标纳入多因素logistic回归分析,确立脱机失败的独立危险因素。应用列线图,建立脱机失败的预测模型。

结果

脱机失败组患者ICU住院时间、住院费用、28 d病死率均显著高于脱机成功组(均P<0.001)。通过多因素logistic回归分析确立了3项高原重症患者脱机失败的独立危险因素,分别为脱机前潮气量(P<0.001,95%CI:0.979~0.992),呼吸频率(P=0.006,95%CI:1.034~1.218),脱机前24 h液体平衡量(P=0.033,95%CI:1.000~1.001)。构建预测模型受试者工作特征曲线的曲线下面积为0.883(95%CI:0.841~0.925)。

结论

高原重症患者脱机失败的独立危险因素为脱机前潮气量,呼吸频率以及脱机前24 h液体平衡量。本研究构建的预测模型具有良好的预测价值。

Objective

To construct a nomogram prediction model to predict the weaning failure for mechanical ventilated patients in plateau areas.

Methods

The patients of 255 cases who required invasive mechanical ventilation admitted to ICU of the People's Hospital of Xizang Autonomous Region from January 1 to December 31, 2023. were enrolled. Patients were divided into successful weaning group (184 cases) and failed weaning group (71 cases) according to whether the mechanical ventilation weaning was successful.The clinical indicators of the patients were collected. Single factor analysis was performed between groups,and statistically significant indicators were brought into multivariate logistic regression analysis to determine independent risk factors for weaning failure. And a nomogram prediction model for weaning failure was established.

Results

The median length of ICU stay, hospitalization cost, the 28-day mortality rate in the offline failure group, which were significantly higher than those in in the offline success group (P<0.001). The multivariate regression analysis established three independent risk factors for weaning failure: tidal volume before weaning (P<0.001, 95%CI: 0.979-0.992), respiratory rate before weaning (P=0.006, 95%CI: 1.034-1.218), and fluid balance in 24 hours before weaning (P=0.033, 95%CI: 1.000-1.001). The area under the ROC curve of the constructed prediction model was 0.883 (95%CI: 0.841-0.925).

Conclusions

The independent risk factors for weaning failure were tidal volume, respiratory rate, and fluid balance. The predictive model constructed for weaning failure in this study has a good predictive value.

表1 脱机失败组和脱机成功组预后指标比较
表2 脱机失败组和脱机成功组相关指标的单因素分析MQ25Q75
相关指标 脱机失败组(71 例) 脱机成功组(184 例) 统计值 P
患者一般情况
 性别[ 例(%)] χ 2 = 0.322a 0.570
  男性 44 (62.0) 121 (65.8)
  女性 27 (38.0) 63 (34.2)
 藏族[ 例(%)] 61 (85.9) 144 (78.3) χ 2 = 1.370 0.242
 年龄(岁) 58 (39,63) 48 (34,59) Z = 2.370 0.018
 BMI(kg/m2 23.44 (20.76,25.71) 22.86 (20.76,24.87) Z = 0.566 0.572
 居住地海拔(m) 3860(3600,4242) 3852(3600,4200) Z = 0.358 0.720
 APACHE Ⅱ评分(分) 17 (13,20) 13 (9,17) Z = 3.894 <0.001
合并症[ 例(%)]
 冠心病 7 (9.8) 9(4.9) χ 2 = 1.388 0.239
 呼吸系统疾病 1 (1.4) 6(3.2) χ 2 = 0.147 0.701
 高血压 40 (56.3) 59 (32.1) χ 2 = 12.709a <0.001
 糖尿病 5 (7.0) 8(4.3) χ 2 = 0.313 0.576
 肝功能不全 3 (4.2) 6(3.3) χ 2 = 0.135 0.713
 吸烟 16 (22.5) 52 (28.3) χ 2 = 0.859a 0.354
脱机当日检验
 白细胞(×109>/L) 1 1.7(9.3,13.8) 10.45 (8.1,13.45) Z = 1.897 0.058
 血小板(×109/L) 192 (122,301) 200 (141,316) Z = 0.476 0.634
 血色素(g/L) 11 4(85,148) 110(93,132) Z = 0.377 0.706
 谷丙转氨酶(U/L) 40 (20,75) 40 (24,79) Z = 0.523 0.601
 总胆红素(mmol/L) 19.4 (10.0,33.7) 15.75 (9.4,24.1) Z = 1.779 0.075
 肌酐(μmol/L) 58 (34,81) 51 (39,63) Z = 1.059 0.290
 C 反应蛋白(ng/ml) 104.92 (61.07,156.72) 74.42 (34.18,118.14) Z = 2.743 0.006
 改良氧合指数(mmHg) 229.0 (210.0,285.0) 301.5 (234.8,356.7) Z = 4.558 <0.001
 二氧化碳分压(mmHg) 33 (29,37) 35 (31,38) Z = 1.228 0.220
 乳酸(mmol/L) 1.1 (0.7,1.5) 0.9 (0.7,1.2) Z = 1.946 0.052
脱机前情况
 体温(℃) 37.1 (36.8,37.4) 37 (36.7,37.2) Z = 2.110 0.035
 心率(次/min) 85 (74,100) 77 (70,90) Z = 3.592 <0.001
 平均动脉压(mmHg) 91 (84,96) 90 (83,97) Z = .096 0.924
 潮气量(ml) 450 (420,470) 542 (480,600) Z = 8.077 <0.001
 呼吸频率(次/min) 23 (20,27) 18 (16,21) Z = 6.549 <0.001
 脱机前24 h 液体平衡量(ml/L) 162 (-859,578) -705(-1109,-340) Z = 5.748 <0.001
 血管活性药物[ 例(%)] 47 (66) 92 (50) χ 2 =5.420a 0.020
表3 影响高原地区重症患者脱机失败的多因素logistic回归分析
图1 高原地区重症患者机械通气脱机失败的列线图预测模型
图2 高原地区重症患者机械通气脱机失败列线图预测模型的校正曲线
图3 高原地区重症患者机械通气脱机失败列线图预测模型的ROC曲线
图4 高原地区重症患者机械通气脱机失败的临床决策曲线
1
孙晓林, 马四清, 潘世琴, 等. 集束化干预策略对高原ICU机械通气患者呼吸机相关性肺炎的预防效果 [J/OL]. 中华重症医学电子杂志, 2021, 7(1): 33-38.
2
杨绍星. 高海拔地区慢性阻塞性肺疾病合并慢性肺源性心脏病急性加重期中医实证证素与临床特征的关联分析 [D]. 青海: 青海大学, 2022.
3
韩同英, 叶琼波, 德吉玉珍, 等. 高海拔地区新生儿呼吸窘迫综合征初始呼吸支持策略的影响因素及早期结局分析 [J]. 中国全科医学, 2022, 25(27): 3384-3389.
4
赵雪丹, 艾悦, 靳国恩, 等. 高海拔地区肺部非感染性疾病的研究新进展 [J]. 中国全科医学, 2025, 28: 1-9.
5
杜安琪, 安友仲, 赵慧颖. 脑出血患者术后延迟脱机的危险因素分析及预测模型建立 [J]. 解放军医学杂志, 2024, 49(10): 1150-1155.
6
Singh J, Zaballa K, Kok H, et al. Cheyne-stokes respiration in children with heart failure [J]. Paediatr Respir Rev, 2022, 43: 78-84.
7
Rose L, Messer B. Prolonged mechanical ventilation, weaning, and the role of tracheostomy [J]. Crit Care Clin, 2024, 40(2): 409-427.
8
Hernández G, Paredes I, Moran F, et al. Effect of postextubation noninvasive ventilation with active humidification vs high-flow nasal cannula on reintubation in patients at very high risk for extubation failure: a randomized trial [J]. Intensive Care Med, 2022, 48(12):1751-1759.
9
Li W, Zhang Y, Wang Z, et al. The risk factors of reintubation in intensive care unit patients on mechanical ventilation: a systematic review and meta-analysis [J]. Intensive Crit Care Nurs, 2023, 74:103340.
10
Zhao H, Wang G, Lyu J, et al. Prediction of mechanical ventilation greater than 24 hours in critically ill obstetric patients: ten years of data from a tertiary teaching hospital in mainland China [J]. BMC Pregnancy Childbirth, 2021, 21(1): 40.
11
Taran S, Wahlster S, Robba C. Ventilatory targets following brain injury [J]. Curr Opin Crit Care, 2023, 29(2): 41-49.
12
Keszler M, Abubakar MK. Volume-targeted ventilation [J]. Semin Perinatol, 2024, 48(2): 151886.
13
Roussos C, Zakynthinos S. Fatigue of the respiratory muscles [J].Intensive Care Med, 1996, 22(2): 134-155.
14
Burns K, Khan J, Phoophiboon V, et al. Spontaneous breathing trial techniques for extubating adults and children who are critically ill: a systematic review and meta-analysis [J]. JAMA Netw Open, 2024,7(2): e2356794.
15
Doorduin J, van der Hoeven JG, Heunks LM. The differential diagnosis for failure to wean from mechanical ventilation [J]. Curr Opin Anaesthesiol, 2016, 29(2): 150-157.
16
Killian HJ, Bakula DM, Wallisch A, et al. Pediatric tube weaning: a meta-analysis of factors contributing to success [J]. J Clin Psychol Med Settings, 2023, 30(4): 753-769.
17
Levine RL. Respiratory rate: the third vital sign [J]. J Am Coll Emerg Physicians Open, 2024, 5(3): e13153.
18
Uchida K. Respiratory rate as a factor in lung injury-not just what you set, but how you set [J]. Anesthesiology, 2023, 138(4): 351-353.
19
Galizia M, Ghidoni V, Catozzi G, et al. Predictors of VILI risk: driving pressure, 4DPRR and mechanical power ratio-an experimental study[J]. Intensive Care Med Exp, 2024, 12(1): 116.
20
程曦, 沈亚伟. 液体负平衡对AECOPD患者有创机械通气的影响[J]. 国际呼吸杂志, 2019, 39(6): 434-438.
21
Lin H, Yao M, Qin Z, et al. Predictive values of ultrasonic diaphragm thickening fraction combined with integrative weaning index in weaning patients with mechanical ventilation: a retrospective study [J].J Cardiothorac Surg, 2024, 19(1): 66.
22
Santos P, Ribas A, Quadros T, et al. Postextubation fluid balance is associated with extubation failure: a cohort study [J]. Rev Bras Ter Intensiva, 2021, 33(3): 422-427.
23
Li T, Zhou D, Zhao D, et al. Association between fluid intake and extubation failure in intensive care unit patients with negative fluid balance: a retrospective observational study [J]. BMC Anesthesiol,2022, 22(1): 170.
24
Cusanno A, Aissaoui N, Minville V, et al. Predictors of weaning failure in case of VA ECMO implantation [J]. Sci Rep, 2022, 12(1): 13842.
25
Burns K, Rochwerg B, Seely A. Ventilator weaning and extubation [J].Crit Care Clin, 2024, 40(2): 391-408.
[1] 张勇, 张立森, 岳良, 张磊磊, 柯海文, 沈运彪. 高原高寒条件下烧伤大鼠代谢指纹图谱绘制及代谢标志物筛选[J/OL]. 中华损伤与修复杂志(电子版), 2025, 20(01): 42-54.
[2] 吉林霞, 范小春, 梁琴. 胃癌常见术后并发症类型及危险因素研究进展[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(02): 220-223.
[3] 杨培容, 潘刚, 周春霞. 胰腺癌术后胰瘘的危险因素及治疗进展[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(02): 228-230.
[4] 奚玲, 仝瀚文, 缪骥, 毛永欢, 沈晓菲, 杜峻峰, 刘晔. 基于肌少症构建的造口旁疝危险因素预测模型[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 48-51.
[5] 林宇腾, 延敏博, 许家榕, 黄子豪, 汤育新. 输尿管软镜手术术后住院时间的影响因素分析[J/OL]. 中华腔镜泌尿外科杂志(电子版), 2025, 19(01): 41-46.
[6] 张红鹤, 杜亚君, 严华艳, 胡艳萍, 杨春旭, 王倩. 食管裂孔疝发生的危险因素分析[J/OL]. 中华疝和腹壁外科杂志(电子版), 2025, 19(01): 92-95.
[7] 李华志, 许臣, 吴永哲. 老年患者经腹腹膜前疝修补术后发生并发症的危险因素分析[J/OL]. 中华疝和腹壁外科杂志(电子版), 2025, 19(01): 96-98.
[8] 张铭杰, 李梦娜, 程明瑶, 王宇亮, 粘永健, 赵瑞臣, 杨宇, 刘慕源, 廖元, 唐超. 高原肺水肿肺超声筛查深度学习模型构建与优化[J/OL]. 中华肺部疾病杂志(电子版), 2025, 18(01): 68-73.
[9] 余承澍, 刘红枝, 林科灿, 林起柱, 黄霆峰, 周伟平, 程张军, 楼健颖, 郑树国, 毕新宇, 王剑明, 郭伟, 李富宇, 王坚, 郑亚民, 李敬东, 程石, 曾永毅. 肝内胆管细胞癌术后极早期复发的危险因素[J/OL]. 中华肝脏外科手术学电子杂志, 2025, 14(01): 53-59.
[10] 李鑫, 李乐, 陈金明, 刘蕊. 基于Meta 分析构建肝癌微血管侵犯的术前预测模型[J/OL]. 中华肝脏外科手术学电子杂志, 2025, 14(01): 74-80.
[11] 任船, 葛荣忠, 邱正才, 朱莉. 肠癌患者术后代谢性酸中毒的预测模型构建及应用价值评价[J/OL]. 中华消化病与影像杂志(电子版), 2025, 15(01): 34-39.
[12] 段红良, 赵红梅, 李涛, 辛建锋. 结直肠癌组织SPOCD1表达与临床病理特征及术后复发转移的关系[J/OL]. 中华消化病与影像杂志(电子版), 2025, 15(01): 40-45.
[13] 洪凡, 王志坚. 瘢痕子宫再妊娠并发症预测模型的研究进展[J/OL]. 中华产科急救电子杂志, 2025, 14(01): 20-25.
[14] 文杨, 刘健, 姚海波, 金梅, 杨胜, 马荣川. 超声心动图联合实验室检查预测静脉注射丙种球蛋白无反应性川崎病的价值[J/OL]. 中华诊断学电子杂志, 2025, 13(01): 51-58.
[15] 刘兴庆, 孟祥洋, 李森, 王海燕, 谢友红, 杨策. 胆碱能α7 烟碱型乙酰胆碱受体通路对高原冲击性脑损伤后肺脏功能的影响研究进展[J/OL]. 中华诊断学电子杂志, 2025, 13(01): 65-70.
阅读次数
全文


摘要


AI


AI小编
你好!我是《中华医学电子期刊资源库》AI小编,有什么可以帮您的吗?