| 杨鑫,王长召,吴翱,等.机械通气老年脓毒症病人早期外周灌注指数、血小板最大聚集率变化对延迟撤机的影响[J].安徽医药,2026,30(10):1959-1963. |
| 机械通气老年脓毒症病人早期外周灌注指数、血小板最大聚集率变化对延迟撤机的影响 |
| Changes in early peripheral perfusion index and maximum platelet aggregation rate in elderly sepsis patients undergoing mechanical ventilation and their effects on delayed withdrawal |
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| DOI：10.3969/j.issn.1009-6469.2026.10.010 |
| 中文关键词: 脓毒症 机械通气 早期外周灌注指数 血小板最大聚集率 延迟撤机 老年人 |
| 英文关键词: Sepsis Mechanical ventilation Early peripheral perfusion index Platelet maximum aggregation rate Delayed withdrawal Aged |
| 基金项目:河南省医学科技攻关计划项目( LHGJ20210972) |
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| 中文摘要: |
| 目的分析机械通气老年脓毒症病人早期外周灌注指数( PPI)、血小板最大聚集率变化及其对延迟撤机的影响。方法该研究采用前瞻性研究方法，以 136例老年脓毒症病人为研究对象，均于 2022年 3月至 2024年 9月在南阳市第二人民医院就诊，均行机械通气治疗。将研究对象根据是否顺利撤机分为延迟撤机组和非延迟撤机组。收集两组病人临床资料及早期 PPI、血小板最大聚集率水平。采用 logistic回归分析筛选影响机械通气老年脓毒症病人延迟撤机的危险因素。绘制受试者操作特征曲线(ROC曲线)分析早期 PPI、血小板最大聚集率及其联合对机械通气老年脓毒症病人延迟撤机的预测价值。结果 136例研究对象中有 46例病人在治疗期间发生延迟撤机，延迟撤机率为 33.82%(46/136)。延迟撤机组重症监护室( ICU)入住时间、机械通气时间、急性生理学和慢性健康状况评价 Ⅱ(APACHEⅡ)、C反应蛋白(CRP)水平高于非延迟撤机组(P<0.05)。延迟撤机组早期 PPI(0.42±0.08比 0.58±0.12)、血小板最大聚集率［( 34.36±4.26)%比( 46.37±5.23)%］水平低于非延迟撤机组( P<0.05)。 ICU入住时间、机械通气时间、 APACHEⅡ、CRP均为机械通气老年脓毒症病人延迟撤机的独立危险因素(P<0.05)，早期 PPI、血小板最大聚集率是机械通气老年脓毒症病人延迟撤机的保护因素( P<0.05)。 ROC曲线结果显示，早期 PPI、血小板最大聚集率联合检测预测机械通气老年脓毒症病人延迟撤机的 AUC、95%CI、灵敏度分别为 0.90、(0.82，0.98)、 93.30%，均优于上述指标单独预测( P<0.001)。结论早期 PPI、血小板最大聚集率均是机械通气老年脓毒症病人延迟撤机的保护因素，对机械通气老年脓毒症病人延迟撤机具有较好的预测价值，且联合检测的预测价值更高。 |
| 英文摘要: |
| Objective To analyze the early changes in peripheral perfusion index (PPI) and maximum platelet aggregation rate in el-derly sepsis patients undergoing mechanical ventilation and their effects on delayed withdrawal. Methods A prospective study wasconducted. A total of 136 elderly sepsis patients treated at Nanyang Second People's Hospital from March 2022 to September 2024were enrolled and treated with mechanical ventilation. The research subjects were classified into a delayed decommissioning group anda non-delayed decommissioning group based on whether the decommissioning was successful. Clinical data, early PPI and maximumplatelet aggregation rate were collected for both groups. Logistic regression analysis was used to identify the risk factors affecting de-layed withdrawal in elderly sepsis patients with mechanical ventilation. Receiver operating characteristic curve (ROC curve) was drawnto evaluate the predictive value of early PPI, maximum platelet aggregation rate and their combination for delayed withdrawal of me-chanical ventilation in elderly patients with sepsis.Results Among the 136 subjects in this study, 46 experienced delayed withdrawalduring treatment, yielding a delayed withdrawal rate of 33.82% (46/136). Compared with the non-delayed withdrawal group, the delayedwithdrawal group had significantly longer length of ICU stay and mechanical ventilation duration, as well as higher acute physiologyand chronic health evaluationⅡ (APACHEⅡ) score and C-reactive protein (CRP) levels (P< 0.05). The early PPI levels (0.42±0.08 vs. 0.58±0.12) and platelet maximum aggregation rate [(34.36±4.26)% vs. (46.37±5.23)%] in the delayed withdrawal group were significant-ly lower than those in the non-delayed withdrawal group (P< 0.05). ICU length of stay, mechanical ventilation duration,, APACHE Ⅱscore and CRP level were identified as independent risk factors for delayed withdrawal of mechanical ventilation in elderly sepsis pa-tients (P<0.05), while early PPI and platelet maximum aggregation rate were protective factors (P<0.05). ROC curve analysis showedthat the combined detection of early PPI and platelet maximum aggregation rate achieved an area under the curve (AUC) of 0.90 [95%CI: (0.82, 0.98)] with a sensitivity of 93.30% for predicting delayed withdrawal, which was superior to either of the above-mentioned indexes alone (P<0.001). Conclusion Early PPI and platelet maximum aggregation rate are protective factors against delayed withdrawal ofmechanical ventilation in elderly sepsis patients, and have a good predictive value for delayed withdrawal, with the combined detectionyielding even higher predictive value. |
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