PaO2/FiO2及LIPS对急性呼吸窘迫综合征患者机械通气脱机失败的预测价值

Predictive value of PaO2/FiO2 and lung injury prediction score for weaning failure in mechanically ventilated patients with acute respiratory distress syndrome

摘要:

目的 探讨膈肌超声动力学参数联合氧合指数（PaO₂/FiO₂）及肺损伤预测评分（LIPS）对急性呼吸窘迫综合征（ARDS）患者机械通气脱机失败的预测价值。方法 选取2023年1月—2025年1月内江市第二人民医院收治的118例接受机械通气的ARDS患者作为研究对象，根据脱机结果分为脱机成功组（81例）和脱机失败组（37例）。所有患者于脱机前24 h内行膈肌超声检测，记录膈肌位移（DE）、膈肌增厚分数（DTF），并同步采集呼吸力学参数及LIPS数据。比较两组间各指标的差异，通过多因素一般Logistic回归模型分析，明确脱机失败的独立危险因素，并绘制受试者工作特征（ROC）曲线评估联合预测模型的效能。结果 失败组机械通气时间长于成功组（P <0.05），LIPS评分和APACHE Ⅱ评分均高于成功组（P <0.05）。成功组DE、DTF均高于失败组（P <0.05）。成功组PaO₂/FiO₂水平高于失败组（P <0.05）。两组pH值、动脉血二氧化碳分压、乳酸、呼吸频率及血氧饱和度比较，差异均无统计学意义（P >0.05）。多因素一般Logistic回归分析结果显示：LIPS评分升高［O^R=3.546（95% CI：1.400，8.981）］和APACHE Ⅱ评分升高［O^R=1.152（95% CI：1.010，1.315）］均为ARDS患者机械通气脱机失败的独立危险因素（P <0.05）；而DE升高［O^R=0.776（95% CI：0.642，0.938）］、DTF升高［O^R=0.817（95% CI：0.741，0.901）］及PaO₂/FiO₂升高［O^R=0.966（95% CI：0.934，0.999）］均为ARDS患者机械通气脱机失败的保护因素（P <0.05）。ROC曲线结果显示，DE、DTF、PaO₂/FiO₂及LIPS评分联合检测的曲线下面积最高，为0.936（95% CI：0.890，0.982），敏感性为83.8%（95% CI：0.680，0.938），特异性为90.1%（95% CI：0.815，0.956）。结论 膈肌超声动力学参数联合PaO₂/FiO₂及LIPS评分能有效预测ARDS患者脱机失败风险，联合模型可为临床脱机决策提供客观依据。

Abstract:

Objective To investigate the predictive value of diaphragmatic ultrasound dynamic parameters combined with oxygenation index (PaO₂/FiO₂) and Lung Injury Prediction Score (LIPS) for weaning failure in mechanically ventilated patients with acute respiratory distress syndrome (ARDS).Methods A total of 118 ARDS patients receiving mechanical ventilation at The Second People's Hospital of Neijiang from January 2023 to January 2025 were enrolled and divided into a weaning success group (n = 81) and a weaning failure group (n = 37) based on outcomes. Diaphragmatic ultrasound was performed within 24 hours before weaning to record diaphragmatic excursion (DE) and diaphragmatic thickening fraction (DTF), along with respiratory mechanics parameters and LIPS scores. Differences between groups were compared, and multivariable logistic regression was used to identify independent risk factors for weaning failure. Receiver operating characteristic (ROC) curves were constructed to evaluate the predictive performance of the combined model.Results The duration of mechanical ventilation was significantly longer in the weaning failure group than in the weaning success group (P < 0.05). In addition, both the LIPS and Acute Physiology and Chronic Health Evaluation II scores were significantly higher in the weaning failure group (P < 0.05). DE and DTF were significantly higher in the weaning success group than in the weaning failure group (P < 0.05). The PaO₂/FiO₂ was also significantly higher in the weaning success group (P < 0.05). No significant differences were observed between the two groups in pH, arterial partial pressure of carbon dioxide, lactate level, respiratory rate, or oxygen saturation (all P > 0.05). Multivariable logistic regression analysis demonstrated that increased LIPS scores [O^R = 3.546 (95% CI: 1.400, 8.981) ] and increased APACHE II scores [O^R = 1.152 (95% CI: 1.010, 1.315) ] were independent risk factors for weaning failure in patients with ARDS. In contrast, increased DE [O^R = 0.776 (95% CI: 0.642, 0.938) ], increased DTF [O^R = 0.817 (95% CI: 0.741, 0.901) ], and increased PaO₂/FiO₂ [O^R = 0.966 (95% CI: 0.934, 0.999) ] were identified as protective factors against weaning failure in ARDS patients (all P < 0.05). ROC curve analysis showed that the combination of DE, DTF, PaO₂/FiO₂, and LIPS scores yielded the highest area under the curve of 0.936 (95% CI: 0.890, 0.982), with a sensitivity of 83.8% (95% CI: 0.680, 0.938) and a specificity of 90.1% (95% CI: 0.815, 0.956).Conclusion The combination of diaphragmatic ultrasound dynamic parameters, PaO₂/FiO₂, and LIPS score effectively predicts weaning failure in ARDS patients, thereby providing an objective basis for clinical weaning decision-making.