保健医学研究与实践2025，Vol.22Issue(7)：19-25,7.DOI:10.11986/j.issn.1673-873X.2025.07.04
老年COPD重症呼吸衰竭患者机械通气后早期拔管失败的影响因素分析及预测模型构建
Risk factors for early extubation failure after mechanical ventilation in elderly COPD patients with severe respiratory failure and construction of a Nomogram prediction model
摘要
Abstract
Objective To investigate the risk factors for early extubation failure after mechanical ventilation in elderly patients with chronic obstructive pulmonary disease(COPD)complicated by severe respiratory failure,and to construct a Nomogram prediction model.Methods We retrospectively enrolled 190 COPD patients with severe respiratory failure who received me-chanical ventilation at Jiangsu Province Hospital from June 2021 to June 2024.The dataset was randomly split into a training set(n=134)and a validation set(n=56)at a 7∶3 ratio;an external validation cohort of 123 mechanically ventilated patients with COPD complicated by severe respiratory failure was collected from other centers.According to whether early extubation failure occurred in the training set,patients were allocated to the failure group(n=20)and the success group(n=114).Clini-cal data were collected and stepwise logistic regression was used to identify factors associated with early extubation failure a-mong these patients.A Nomogram predicting early extubation failure was constructed using R 4.3.1.The model's discrimina-tion and calibration were assessed by receiver operating characteristic(ROC)curves and the Hosmer-Lemeshow goodness-of-fit test;decision curve analysis(DCA)was plotted to evaluate clinical utility.Results Compared with the success group,patients in the failure group were older,had higher arterial partial pressure of carbon dioxide(PaCO2),lower arterial partial pressure of oxygen(PaO2),higher N-terminal pro-brain natriuretic peptide(NT-proBNP)levels,longer duration of mechanical ventila-tion,higher C-reactive protein(CRP)levels,and lower albumin levels;all differences were statistically significant(P＜0.05).Stepwise logistic regression identified age(OR=1.641,95％CI:1.307-2.060),duration of mechanical ventilation(OR=1.476,95％CI:1.220-1.785),CRP(OR=1.352,95％CI:1.153-1.585),and albumin(OR=0.857,95％CI:0.778-0.943)as independent risk factors for early extubation failure in elderly COPD patients with severe respiratory failure(P＜0.05).Based on these variables,a Nomogram prediction model was constructed;the model's concordance index(C-index)was 0.83(95％CI:0.81-0.85)and the calibration curve slope approached 1.In the internal validation set,the Nomogram a-chieved an AUC of 0.934(95％CI:0.882-0.985),and in the external validation cohort,the AUC was 0.985(95％CI:0.957-1.000).DCA indicated that the Nomogram has substantial clinical value for predicting the risk of early extubation fail-ure in elderly COPD patients with severe respiratory failure.Conclusion Age,duration of mechanical ventilation,albumin,and CRP are influencing factors for early extubation failure after mechanical ventilation in elderly COPD patients with severe re-spiratory failure.The Nomogram constructed from these factors demonstrates good predictive performance.关键词
老年慢性阻塞性肺疾病/重症呼吸衰竭/机械通气/早期拔管失败/危险因素/Nomogram预测模型Key words
Elderly chronic obstructive pulmonary disease/Severe respiratory failure/Mechanical ventilation/Early extubation failure/Risk factors/Nomogram prediction model分类
医药卫生引用本文复制引用
潘慧敏,周立杰,马宝静,万里红,张银萍,李玉,张玉萍..老年COPD重症呼吸衰竭患者机械通气后早期拔管失败的影响因素分析及预测模型构建[J].保健医学研究与实践,2025,22(7):19-25,7.基金项目
江苏省卫生健康委老年健康科研项目(LKM2022002). （LKM2022002）
