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目的评价采用流速充气袋自主呼吸试验(SBT)预测拔管是否成功的价值;其次评价15minSBT阳性与阴性预测精确度。设计前瞻性盲法临床研究地点大学附属医院儿童重症监护病房研究对象插管>24h的患儿。干预所有达到拔管条件的患儿,连接可提供5cmH2O持续气道正压的流量充气气囊,进行15min自主呼吸。测量与主要结果70例患儿进行SBT。分别于基础状态、SBT5min与15min记录呼吸频率、心率、血压和脉搏血氧饱和度。SBT结束后所有患儿均拔管,ICU医师不知试验结果。随后24h内继续观察病人,记录需无创通气或再次插管人数(如拔管失败)。64例患儿通过SBT,其中7·8%拔管失败(仅1·6%需再次插管)。6/70例患儿试验失败,但半数拔管成功。成功通过SBT,预测拔管成功的敏感性为95%,阳性预测值92%,优势比为12(95%可信区间1·3,53·7)。SBT特异性37%,阴性预测值50%。Logistic回归分析显示,能通过SBT与成功拔管有显著关系(P=0·017)。结论15min流量充气式气囊自主呼吸试验是一种实用而且可信的床边试验,它预测PICU拔管成功的敏感性为95%。试验失败与预测拔管失败有关,但不精确。
Objective To evaluate the value of predicting the success of extubation using flow-rate inflation bag spontaneous breath test (SBT). Second, evaluate the positive and negative predictive accuracy of SBT for 15 min. Design Prospective Blind Clinical Studies Location University Admissions Hospital Children’s ICU Ward Study subjects Children with intubation> 24h. Interventions All children with extubation were connected to a flow inflatable balloon capable of delivering 5 cmH2O of continuous positive airway pressure for 15 minutes of spontaneous breathing. Measurements with primary outcome in 70 children undergoing SBT. Respiratory rate, heart rate, blood pressure and pulse oximetry were recorded at basal state, SBT5min and 15min respectively. All patients underwent extubation after SBT, and ICU physicians did not know the test results. Followed within 24h follow-up observation of patients, the need for non-invasive ventilation or re-intubation number (such as extubation failure). Sixty-four children underwent SBT, of whom 7.8% had failed extubation (only 1.6% needed re-intubation). 6/70 children failed the trial, but half of the successful extubation. Successful SBT predicts a successful extubation of 95%, a positive predictive value of 92%, and a odds ratio of 12 (95% confidence interval, 1.53 · 7). SBT-specific 37%, negative predictive value of 50%. Logistic regression analysis showed that there was a significant relationship between SBT and extubation (P = 0.017). Conclusion The 15-min inflatable balloon-assisted spontaneous breath test is a practical and credible bedside test that predicts a 95% sensitivity of successful PICU extubation. Failure to test failed to predict extubation, but not precise.