Wang Nianci, Qin Haidong, Bao Lei
Department of Emergency Medicine, Nanjing First Hospital, Nanjing Medical University, Nanjing, Jiangsu, 210006, People's Republic of China.
Sci Rep. 2025 Feb 8;15(1):4722. doi: 10.1038/s41598-025-89195-7.
To explore the role of AVAPS combined with TCM monitoring in the weaning of patients with AECOPD. In this study, 100 patients with AECOPD were included, who were divided into the AVAPS group and the S/T group after weaning. The respiration-related parameters were compared between the two groups at the time of weaning and after 1 h and 12 h of noninvasive ventilation. The correlations between PtcCO and PaCO and the differences in each parameter were compared. The predictive value of PtcCO variability after 1 h and 12 h of noninvasive respiratory support for the 48-h reintubation rate were analysed. Logistic regression analysis was performed to explore the risk factors affecting the 48-h reintubation rate of AECOPD patients. After 1 h and 12 h of treatment with different ventilation modes, the variations in the respiration-related parameters in the AVAPS group were all significantly greater than those in the S/T group (P < 0.05). In the AVAPS group, the incidence of 48-hour reintubation was lower, the time to reintubation was longer, and length of hospital and ICU stays were shorter (P < 0.05). The ROC curve revealed that PtcCO variability, the ROX index and their combination had predictive value for the 48-h reintubation rate of AECOPD patients. The logistic regression revealed that after 12 h of noninvasive support, a PtcCO variability ≥ - 5.8% with a ROX index ≤ 9.6 was independent risk factors affecting the 48 h reintubation rate in weaning patients with AECOPD (OR = 2.815; P < 0.05). For patients with AECOPD, the AVAPS ventilation mode combined with PtcCO monitoring can significantly improve respiratory physiological parameters and reduce the 48 h reintubation rate. After 12 h of noninvasive support, a PtcCO variability ≥ - 5.8% with a ROX index ≤ 9.6 is considered as a independent risk factor for reintubation 48 h after weaning.
探讨适应性支持通气(AVAPS)联合中医监测在慢性阻塞性肺疾病急性加重期(AECOPD)患者撤机中的作用。本研究纳入100例AECOPD患者,撤机后分为AVAPS组和同步间歇指令通气(S/T)组。比较两组在撤机时、无创通气1小时和12小时后的呼吸相关参数。比较经皮二氧化碳分压(PtcCO)与动脉血二氧化碳分压(PaCO)之间的相关性以及各参数的差异。分析无创呼吸支持1小时和12小时后PtcCO变异性对48小时再插管率的预测价值。进行Logistic回归分析以探讨影响AECOPD患者48小时再插管率的危险因素。采用不同通气模式治疗1小时和12小时后,AVAPS组呼吸相关参数的变化均显著大于S/T组(P<0.05)。AVAPS组48小时再插管发生率较低,再插管时间较长,住院时间和重症监护病房(ICU)住院时间较短(P<0.05)。ROC曲线显示,PtcCO变异性、氧合指数(ROX指数)及其联合指标对AECOPD患者48小时再插管率具有预测价值。Logistic回归显示,无创支持12小时后,PtcCO变异性≥ - 5.8%且ROX指数≤9.6是影响AECOPD撤机患者48小时再插管率的独立危险因素(比值比[OR]=2.815;P<0.05)。对于AECOPD患者,AVAPS通气模式联合PtcCO监测可显著改善呼吸生理参数并降低48小时再插管率。无创支持12小时后,PtcCO变异性≥ - 5.8%且ROX指数≤9.6被认为是撤机后48小时再插管的独立危险因素。