Scheinhorn D J, Hassenpflug M, Artinian B M, LaBree L, Catlin J L
Barlow Respiratory Hospital, Los Angeles, CA 90026-2696.
Chest. 1995 Feb;107(2):500-5. doi: 10.1378/chest.107.2.500.
To identify variables associated with weaning outcome in long-term ventilator-dependent patients. Using those variables, to construct models to predict weaning success and to test the accuracy of those models.
Retrospective medical record review.
Regional weaning center (RWC).
An initial group of 421 and a subsequent group of 170 consecutive patients referred for attempted weaning after 6 weeks of mechanical ventilation.
Data obtained on admission to our facility were analyzed for correlation with weaning outcome. In the initial patient group, selected variables which correlated with weaning success were alveolar-arterial oxygen pressure difference (P[A-a]O2), BUN, BUN/creatinine ratio (each with p < or = 0.001), and female gender (p = 0.04). We used these variables in logistic regression models to predict weaning success in this population. We then tested the models in the 170-patient validation group using both standard and receiver operating characteristic (ROC) curve analysis. The ROC analysis indicated 59% accuracy using P(A-a)O2 alone and 68% accuracy using all previously mentioned variables. We used data from all 565 patients with known outcome and omitted BUN/creatinine ratio to fashion a simple scoring system to predict weaning success with 70% accuracy using P(A-a)O2, BUN, and Gender--the A+B+G score.
In patients suffering prolonged mechanical ventilation, models incorporating simple measurements allowed construction of a score to predict weaning success at our RWC.
确定与长期依赖呼吸机患者撤机结果相关的变量。利用这些变量构建预测撤机成功的模型，并检验这些模型的准确性。
回顾性病历审查。
地区撤机中心（RWC）。
最初一组421例，以及随后一组170例在机械通气6周后被转诊尝试撤机的连续患者。
分析患者入住本机构时获得的数据与撤机结果的相关性。在最初的患者组中，与撤机成功相关的选定变量为肺泡-动脉血氧分压差（P[A-a]O2）、血尿素氮（BUN）、BUN/肌酐比值（各p≤0.001）以及女性性别（p = 0.04）。我们将这些变量用于逻辑回归模型，以预测该人群的撤机成功情况。然后，我们在170例患者的验证组中使用标准分析和受试者工作特征（ROC）曲线分析对模型进行检验。ROC分析表明，仅使用P(A-a)O2时准确率为59%，使用所有上述变量时准确率为68%。我们使用了所有565例已知结果患者的数据，并省略BUN/肌酐比值，构建了一个简单的评分系统，即使用P(A-a)O2、BUN和性别（A+B+G评分）预测撤机成功，准确率为70%。
在长期机械通气的患者中，纳入简单测量指标的模型可用于构建评分系统，以预测我们RWC的撤机成功情况。
