呼气末二氧化碳分压、C-反应蛋白/白蛋白比值及综合脱机指数对重型颅脑损伤机械通气患者撤机失败的预测价值

摘要 目的：探讨呼气末二氧化碳分压（PetCO₂）、C-反应蛋白/白蛋白比值（CRP/Alb）及综合脱机指数（IWI）对重型颅脑损伤机械通气患者撤机失败的预测价值。方法：选择2020年1月至2022年6月在安徽中医药大学附属六安医院进行机械通气的重型颅脑损伤患者96例作为研究对象，按照撤机结局分为撤机失败组（n=31）和撤机成功组（n=65）。比较两组撤机前PetCO₂、CRP/Alb、IWI及临床参数。应用多因素Logistic回归分析重型颅脑损伤机械通气患者撤机失败的危险因素。应用受试者工作特征（ROC）曲线评价PetCO₂、CRP/Alb、IWI对重型颅脑损伤机械通气患者撤机失败的预测价值。结果：撤机失败组PetCO₂、CRP/Alb、急性生理功能和慢性健康状况评分系统II（APACHE II）评分显著高于撤机成功组，机械通气时间长于撤机成功组，IWI、格拉斯哥昏迷评分（GCS）显著低于撤机成功组（P<0.05）。多因素Logistic回归分析显示，PetCO₂≥37.01 mmHg、CRP/Alb≥0.97、IWI≤78.23、GCS≤5.90分、APACHE II评分≥26.17分、机械通气时间≥4.49 d是重型颅脑损伤机械通气患者撤机失败的危险因素（P<0.05）。ROC曲线分析结果显示PetCO₂、CRP/Alb、IWI、GCS、APACHE II对重型颅脑损伤机械通气患者撤机失败均有较高的敏感度、特异度， PetCO₂、CRP/Alb、IWI三项联合检测对重型颅脑损伤机械通气患者撤机失败预测的曲线下面积（AUC）高于PetCO₂、CRP/Alb、IWI、GCS、APACHE II单独检测。结论：PetCO₂、CRP/Alb及IWI联合评估对重型颅脑损伤机械通气患者撤机失败具有较高的预测价值。

Predictive Value of End-Tidal Carbon Dioxide Partial Pressure, C-Reactive Protein/Albumin Ratio and Integrated Weaning Index on Weaning Failure in Patients with Severe Craniocerebral Injury Undergoing Mechanical Ventilation

ABSTRACT Objective: To investigate the predictive value of end-tidal carbon dioxide partial pressure (PetCO₂), C-reactive protein/albumin ratio (CRP/Alb) and integrated weaning index (IWI) on weaning failure in patients with severe craniocerebral injury undergoing mechanical ventilation. Methods: 96 patients with severe craniocerebral injury who underwent mechanical ventilation in Lu''an Hospital Affiliated to Anhui University of Traditional Chinese Medicine from January 2020 to June 2022 were selected as research objects, according to the withdrawal results, they were divided into the weaning failure group(n=31) and the weaning success group (n=65). PetCO₂, CRP/Alb, IWI and clinical parameters in the two groups before weaning were compared. Multivariate Logistic regression was used to analyze the risk factors of weaning failure in patients with severe craniocerebral injury undergoing mechanical ventilation. The predictive value of PetCO₂, CRP/Alb and IWI for weaning failure in patients with severe craniocerebral injury undergoing mechanical ventilation was evaluated by receiver operating characteristic(ROC) curve. Results: PetCO₂, CRP/Alb, acute physiology and chronic health evaluation scoring system II (APACHE II) score in the weaning failure group were significantly higher than those in the weaning success group, mechanical ventilation time was longer than that in the weaning success group, while IWI and glasgow coma score (GCS) were significantly lower than those in the weaning success group(P<0.05). Multivariate Logistic regression analysis showed that PetCO₂≥37.01 mmHg, CRP/Alb≥0.97, IWI≤78.23, GCS≤5.90 scores, APACHE II score≥26.17 scores, mechanical ventilation time≥4.49 d were the risk factors of weaning failure in patients with severe craniocerebral injury undergoing mechanical ventilation (P<0.05). The ROC curve analysis showed that PetCO₂, CRP/Alb, IWI, GCS, APACHE II had high sensitivity and specificity for the weaning failure in patients with severe craniocerebral injury undergoing mechanical ventilation. The area under the curve(AUC) predicted by the combined detection of PetCO₂, CRP/Alb, IWI for the weaning failure in patients with severe craniocerebral injury undergoing mechanical ventilation was higher than that of PetCO₂, CRP/Alb, IWI, GCS, APACHE II alone. Conclusion: The combined assessment of PetCO₂, CRP/Alb and IWI has high predictive value for the weaning failure in patients with severe craniocerebral injury undergoing mechanical ventilation.