摘要
目的探究心肺联合超声(CPUS)检查评估新生儿严重低氧血症(HO)机械通气撤机情况的临床价值。方法选择2017年1月—2022年8月于雅安市人民医院治疗的严重HO新生儿(68例)为研究对象,纳入训练集;根据撤机是否失败,分为成功组(48例)和失败组(20例)。按照相同标准另选2022年9月—2023年3月于本院治疗的严重HO新生儿(25例)纳入验证集,以验证预测模型的有效性。收集患儿的临床资料以及影像学指标,进行对比分析。采用受试者工作特征(ROC)曲线分析CPUS检查的诊断价值。采用多因素Logistic回归分析影响撤机失败的危险因素,建立反向传播(BP)神经网络预测模型,并进行模型评价。结果机械通气时间>7.5 d、吸痰耐受能力差、撤机时自主呼吸频率≥53次/min、撤机时心率>155次/min、二氧化碳分压(PaCO_(2))>47 mmHg、肺部超声评分(LUS)≥10分、左心室射血分数(LVEF)<55.5%以及舒张早期二尖瓣血流速度与环运动速度比值(E/E’)>8.5,均是撤机失败的危险因素(P<0.05)。BP神经网络模型的隐含层节点数为4时,交叉验证的均方根误差最小。ROC曲线、校准曲线和临床决策曲线(DCA)显示该预测模型的区分度、准确性和有效性均较高。与各指标单独检测相比,CPUS检查的曲线下面积(AUC)(0.913,95%CI:0.853~0.971)更高,灵敏度和特异度分别为0.902和0.811。结论机械通气时间>7.5 d、吸痰耐受能力差、撤机时自主呼吸频率≥53次/min、撤机时心率>155次/min、PaCO_(2)>47 mmHg、LUS≥10分、LVEF<55.5%以及E/E’>8.5,均是撤机失败的独立危险因素。CPUS检查评估新生儿严重HO机械通气撤机失败的临床价值较高。
Objective To explore the clinical value of cardiopulmonary ultrasound(CPUS)in evaluating the weaning of neonates with severe hypoxemia(HO)mechanical ventilation.Methods 68 cases neonates with severe HO who were treated in Ya'an People's Hospital from January 2017 to August 2022 were selected as research objects and included in the training set;According to whether the weaning failed,they were divided into successful group(48 cases)and failed group(20 cases).According to the same criteria,25 cases neonates with severe HO who were treated in our hospital from September 2022 to March 2023 were included in the validation set to verify the effectiveness of the prediction model.Collect the clinical data and imaging indicators of children,and conduct comparative analysis.The diagnostic value of CPUS was analyzed by receiver operating characteristic(ROC)curve.Multifactor Logistic regression analysis was used to analyze the risk factors of evacuation failure,and back propagation(BP)neural network prediction model was established and evaluated.Results Time of mechanical ventilation>7.5 days,poor sputum tolerance,rate of spontaneous respiration during weaning≥53 times/min,heart rate at weaning>155 times/min,partial pressure of carbon dioxide(PaCO_(2))>47 mmHg,lung ultrasound score(LUS)≥10 points,left ventricular ejection fraction(LVEF)<55.5%and ratio of early diastolic mitral valve blood flow velocity to annular motion velocity(E/E')>8.5 were risk factors for weaning failure(P<0.05).When the number of hidden layer nodes of BP neural network model was 4,the root mean square error of cross validation was the minimum.ROC curve,calibration curve and decision curve analysis(DCA)showed that the discrimination,accuracy and effectiveness of the prediction model were high.Compared with each index detected separately,the area under curve(AUC)(0.913,95%CI:0.853-0.971)of CPUS was higher,and the sensitivity and specificity were 0.902 and 0.811 respectively.Conclusion Mechanical ventilation time>7.5 d,poor sputum tolerance,rate of spontaneous respiration during weaning≥53 times/min,heart rate at weaning>155 times/min,PaCO_(2)>47 mmHg,LUS≥10 points,LVEF<55.5%and E/E'>8.5 were independent risk factors for weaning failure.The clinical value of CPUS in evaluating the weaning failure of neonates with severe HO is high.
作者
梅林
陈伟
邹永蓉
刘艳午
何玉婷
李鲜
MEI Lin;CHEN Wei;ZOU Yongrong;LIU Yanwu;HE Yuting;LI Xian(Department of Neonatology,Ya'an People's Hospital,Ya'an Sichuan 625000,China)
出处
《中国急救复苏与灾害医学杂志》
2024年第3期368-373,共6页
China Journal of Emergency Resuscitation and Disaster Medicine
基金
雅安市科学技术局(编号:22KTJHO026)。
关键词
心肺联合超声
新生儿
低氧血症
机械通气
临床价值
Cardiopulmonary ultrasound
Neonatus
Hypoxemia
Mechanical ventilation
Clinical value
