| 王莎,凌萍,杨仕秘,等.呼吸末二氧化碳分压、呼吸浅快指数对儿童重症肺炎机械通气病儿撤机预测价值[J].安徽医药,2026,30(7):1399-1403. |
| 呼吸末二氧化碳分压、呼吸浅快指数对儿童重症肺炎机械通气病儿撤机预测价值 |
| The predictive value of end tidal carbon dioxide partial pressure and shallow rapid breathing index for mechanical ventilation withdrawal in children with severe pneumonia |
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| DOI：10.3969/j.issn.1009-6469.2026.07.025 |
| 中文关键词: 通气机撤除法 呼吸，人工 呼气末二氧化碳分压 呼吸浅快指数 儿童 肺炎 撤机预测 |
| 英文关键词: Ventilator weaning Respiration, artificial End expiratory carbon dioxide partial pressure Rapid shallow breathing index Child Pneumonia Evacuation prediction |
| 基金项目:贵州省卫生健康委科学技术基金项目( gzwkj2022-401) |
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| 中文摘要: |
| 目的分析呼吸末二氧化碳分压( PetCO2)及呼吸浅快指数( RSBI)监测在儿童重症肺炎机械通气治疗中的撤机预测价值。方法前瞻性选取 2023年 12月至 2024年 6月贵阳市妇幼保健院儿童重症监护室( pediatric intensive care unit，PICU)PICU收治并进行机械通气的该时间段符合条件的所有重症肺炎病儿共 102例，所有病儿均采用合适年龄的气管型号，使用同一型号呼吸机，采取同样的呼吸机模式、相近呼吸机参数，撤机实验通过后撤除呼吸机，按照撤机后 48 h内无需再次无创或有创机械通气判定撤机成功，根据撤机结局分为撤机成功组( n=85)和失败组( n=17)比较两组各指标水平，绘制受试者操作特征曲(ROC曲线)图并计算曲线下面积(AUC)分别评价 PetCO2和 RSBI对撤机成功的，预测价值。结果 102例病儿中，撤机成功占83线.33%(85/102)，撤机失败占 16.67%(17/102)。撤机成功组和撤机失败组性别、年龄、机械通气时间、动态顺应性、危重症评分、心率、舒张压、平均动脉压、 pH、撤机前二氧化碳分压、撤机前氧分压、撤机前外周血氧饱和度( saturation of peripheral oxy-gen，SPO2)、撤机前氧合指数、撤机后 pH比较，均差异无统计学意义(P>0.05)。撤机成功组与撤机失败组的撤机前潮气量［ 82.0(47.5，117.0)mL/kg比 61.0(39.5，76.5)mL/kg］、收缩压［(91.53±10.22)mmHg比( 85.18±12.24)mmHg］(1 mmHg=0.133 kPa)、撤机后氧合指数［(343.56±139.30)mmHg比( 147.71±73.56)mmHg］、撤机后氧分压［(119.67±41.60)mmHg比( 63.00±28.66)mmHg］比较，撤机成功组高于撤机失败组( P<0.05)。撤机成功组与撤机失败组的 RSBI、撤机前氧浓度、撤机前呼吸频率、撤机后氧浓度、撤机后二氧化碳分压、 PetCO2比较，撤机成功组低于撤机失败组( P<0.05)。 ROC曲线分析显示， RSBI在预测儿童重症肺炎机械通气病儿撤机成功的 AUC 95%CI为 0.71(0.61，0.81)灵敏度 0.94，特异度 0.54，特异度较低；而 PetCO2在预测儿童重症肺炎机械通气病儿撤机成功的效能最优，其 AUC 95%CI为 0.93(0.86，1.00)，灵敏度达 0.94，特异度达 0.88。结论 PetCO2、RSBI 均对儿童重症肺炎机械通气病儿撤机结局预测具有指导作用，且以 PetCO2的预测价值最高。 |
| 英文摘要: |
| Objective To analyze the predictive value of end tidal carbon dioxide partial pressure (PetCO2) and rapid shallow breath-ing index (RSBI) monitoring for mechanical ventilation withdrawal in children with severe pneumonia.Methods Prospective selectiona total of 102 critically ill children with pneumonia, who were admitted to the pediatric intensive care unit (PICU) of Guiyang Maternaland Child Health Hospital from December 2023 to June 2024 and underwent mechanical ventilation during this period, were selected.All children used age-appropriate tracheal tube sizes, and were ventilated using the same ventilator mode, with the same ventilationmode and similar ventilator parameters. After the patient passed the spontaneous breathing trial, the ventilator was removed, and suc-cessful weaning was defined as no need for non-invasive or invasive mechanical ventilation within 48 hours following extubation. Ac-cording to the weaning outcome, the children were divided into a weaning success group (n=85) and a weaning failure group (n=17). The levels of each indicator in the two groups were compared, and the receiver operating characteristic curves (ROC curves) of the sub-jects were drawn. The area under the curve (AUC) was calculated to evaluate the predictive value of PetCO2 and RSBI for the success of machine removal.Results Among the 102 sick children, 85 (83.33%) cases were successfully withdrawn from the machine, and 17(16.67%) cases were unsuccessful. There were no statistically significant differences between the weaning success group and the wean-ing failure group in terms of gender, age, duration of mechanical ventilation, dynamic compliance, critical illness score, heart rate, dia-stolic blood pressure, mean arterial pressure, pH, partial pressure of carbon dioxide before weaning, partial pressure of oxygen beforeweaning, saturation of peripheral oxygen (SPO2) before weaning, oxygenation index before weaning, and pH after weaning (P>0.05). Compareed with the weaning failure group, the weaning success group showed significant higher values in .pre-weaning tidal volume [82.0 (47.5117.0) mL/kg vs. 61.0 (39.5, 76.5) mL/kg], systolic blood pressure [(91.53±10.22) mmHg vs. (85.18±12.24) mmHg](1 mmHg=0.133 kPa), post-weaning oxygenation index [(343.56±139.30) mmHg vs. (147.71±73.56) mmHg], and post-weaning partial pressure of oxygen [(119.67±41.60) mmHg vs. (63.00±28.66) mmHg] (P<0.05), and significantly lower values in RSBI, pre-weaning oxygen concen-tration, pre-weaning respiratory rate, post-weaning oxygen concentration, post-weaning partial pressure of carbon dioxide, and PetCO2 (P <0.05)..ROC curve analysis showed that the AUC 95%CI of RSBI in predicting successful weaning of mechanically ventilated childrenwith severe pneumonia was 0.71 (0.61, 0.81), with a sensitivity of 0.94 and a specificity of 0.54, indicating low specificity; PetCO2 had the best efficacy in predicting the success of mechanical ventilation withdrawal in children with severe pneumonia, with an AUC 95%CI of 0.93 (0.86, 1.00), sensitivity of 0.94, and specificity of 0.88.Conclusion Both PetCO2 and RSBI have a guiding role in predicting theoutcome of mechanical ventilation withdrawal in children with severe pneumonia, and PetCO2 has the superior predictive value. |
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