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目的:探讨N端脑钠素前体(NT-proBNP)水平联合中心静脉压(CVP)监测在机械通气患者撤机过程中的指导作用。方法:回顾性分析2010-11-2012-12我科(ICU)100例行机械通气患者的病例资料。达到撤机条件后,根据自主呼吸试验标准(SBT)逐步进行撤机,根据48h内的撤机结果,分为撤机成功组(76例)和撤机失败组(24例)。比较2组患者入院时和撤机后的NT-proBNP、CVP水平,并比较2组患者撤机前后48h内的液体平衡量和呼吸频率(BR)的变化。结果:入院时,2组NT-proBNP和CVP水平比较差异无统计学意义。撤机后,2组NT-proBNP、CVP水平较入院时明显降低(均P<0.05),撤机成功组NT-proBNP、CVP水平较撤机失败组明显降低(P<0.05)。撤机前后48h液体平衡量比较,撤机成功组呈负平衡,撤机失败组呈正平衡。撤机48h内,撤机成功组BR较撤机失败组改善(P<0.05)。结论:NT-proBNP水平变化联合CVP监测对机械通气患者的撤机有指导作用,一定程度上可以提高撤机成功率。
Objective: To investigate the role of N-terminal pro-brain natriuretic peptide (NT-proBNP) level and central venous pressure (CVP) monitoring in weaning of patients with mechanical ventilation. Methods: A retrospective analysis of 2010-11-2012-12 department (ICU) 100 cases of patients with mechanical ventilation case data. After the weaning condition was met, weaning was gradually carried out according to spontaneous breathing test (SBT). According to the results of weaning within 48 hours, there were two groups: the weaning success group (76 cases) and the weaning failure group (24 cases). The levels of NT-proBNP and CVP at admission and after weaning were compared between the two groups. The changes of fluid balance and respiratory rate (BR) within 48 hours before and after weaning were compared between the two groups. Results: At admission, there was no significant difference in NT-proBNP and CVP levels between the two groups. After weaning, the levels of NT-proBNP and CVP in two groups were significantly lower than those on admission (all P <0.05). The levels of NT-proBNP and CVP in weaning success group were significantly lower than those in weaning failure group (P <0.05). 48 h before and after weaning compared the amount of fluid balance, weaning success was negative balance, weaning failure was positive balance. Within 48h after weaning, the successful weaning group BR improved more than the weaning failure group (P <0.05). CONCLUSION: The change of NT-proBNP level and CVP monitoring may play a guiding role in the weaning of patients with mechanical ventilation and to a certain extent, improve the success rate of weaning.