Ma Gang, Liao Wei, Qiu Junke, Su Quanguan, Fang Yi, Gu Baochun
Department of Intensive Care Medicine, Cancer Center, Sun Yat-sen University, Guangzhou, China.
J Int Med Res. 2013 Oct;41(5):1612-21. doi: 10.1177/0300060513490085. Epub 2013 Aug 1.
To evaluate the relationship between plasma N-terminal prohormone B-type natriuretic peptide (NT-proBNP) and weaning outcomes, and the ability of NT-proBNP level to predict weaning success, in cancer patients with pulmonary complications undergoing noncardiac major surgeries.
Patients who were mechanically ventilated following postoperative respiratory failure were enrolled. NT-proBNP levels at the end of a 2-h spontaneous breathing trial were measured. Weaning was considered a success in patients who completed the trial and maintained spontaneous breathing following extubation for >48 h.
Out of 29 patients, 22 patients weaned successfully but weaning failed in 7 patients. Plasma NT-proBNP was significantly higher in the weaning failure group than in the weaning success group. For predicting weaning success, the optimal NT-proBNP threshold value at the end of the spontaneous breathing trial was <448 ng/l (receiver operating characteristic analysis; sensitivity 68.18%, specificity 85.71%, positive predictive value 93.7% and negative predictive value 46.2%).
Measuring NT-proBNP at the end of a spontaneous breathing trial may assist in predicting weaning success, as a noninvasive, quantitative and repeatable indicator of cardiac stress in patients with postsurgical respiratory failure.
评估非心脏大手术并发肺部并发症的癌症患者血浆N末端B型利钠肽原（NT-proBNP）与脱机结果之间的关系，以及NT-proBNP水平预测脱机成功的能力。
纳入术后呼吸衰竭后接受机械通气的患者。测量2小时自主呼吸试验结束时的NT-proBNP水平。完成试验并在拔管后自主呼吸维持>48小时的患者被认为脱机成功。
29例患者中，22例成功脱机，7例脱机失败。脱机失败组的血浆NT-proBNP显著高于脱机成功组。为预测脱机成功，自主呼吸试验结束时的最佳NT-proBNP阈值为<448 ng/l（受试者工作特征分析；敏感性68.18%，特异性85.71%，阳性预测值93.7%，阴性预测值46.2%）。
在自主呼吸试验结束时测量NT-proBNP，作为术后呼吸衰竭患者心脏应激的一种无创、定量且可重复的指标，可能有助于预测脱机成功。
