中国现代医学杂志2026，Vol.36Issue(12)：27-33,7.DOI:10.3969/j.issn.1005-8982.2026.12.005
PaO2/FiO2及LIPS对急性呼吸窘迫综合征患者机械通气脱机失败的预测价值
Predictive value of PaO2/FiO2 and lung injury prediction score for weaning failure in mechanically ventilated patients with acute respiratory distress syndrome
摘要
Abstract
Objective To investigate the predictive value of diaphragmatic ultrasound dynamic parameters combined with oxygenation index(PaO2/FiO2)and Lung Injury Prediction Score(LIPS)for weaning failure in mechanically ventilated patients with acute respiratory distress syndrome(ARDS).Methods A total of 118 ARDS patients receiving mechanical ventilation at The Second People's Hospital of Neijiang from January 2023 to January 2025 were enrolled and divided into a weaning success group(n=81)and a weaning failure group(n=37)based on outcomes.Diaphragmatic ultrasound was performed within 24 hours before weaning to record diaphragmatic excursion(DE)and diaphragmatic thickening fraction(DTF),along with respiratory mechanics parameters and LIPS scores.Differences between groups were compared,and multivariable logistic regression was used to identify independent risk factors for weaning failure.Receiver operating characteristic(ROC)curves were constructed to evaluate the predictive performance of the combined model.Results The duration of mechanical ventilation was significantly longer in the weaning failure group than in the weaning success group(P＜0.05).In addition,both the LIPS and Acute Physiology and Chronic Health Evaluation Ⅱ scores were significantly higher in the weaning failure group(P＜0.05).DE and DTF were significantly higher in the weaning success group than in the weaning failure group(P＜0.05).The PaO2/FiO2 was also significantly higher in the weaning success group(P＜0.05).No significant differences were observed between the two groups in pH,arterial partial pressure of carbon dioxide,lactate level,respiratory rate,or oxygen saturation(all P＞0.05).Multivariable logistic regression analysis demonstrated that increased LIPS scores[(OR)=3.546(95％CI:1.400,8.981)]and increased APACHE Ⅱ scores[(OR)=1.152(95％CI:1.010,1.315)]were independent risk factors for weaning failure in patients with ARDS.In contrast,increased DE[(OR)=0.776(95％CI:0.642,0.938)],increased DTF[(OR)=0.817(95％CI:0.741,0.901)],and increased PaO2/FiO2[(OR)=0.966(95％CI:0.934,0.999)]were identified as protective factors against weaning failure in ARDS patients(all P＜0.05).ROC curve analysis showed that the combination of DE,DTF,PaO2/FiO2,and LIPS scores yielded the highest area under the curve of 0.936(95％CI:0.890,0.982),with a sensitivity of 83.8％(95％CI:0.680,0.938)and a specificity of 90.1％(95％CI:0.815,0.956).Conclusion The combination of diaphragmatic ultrasound dynamic parameters,PaO2/FiO2,and LIPS score effectively predicts weaning failure in ARDS patients,thereby providing an objective basis for clinical weaning decision-making.关键词
急性呼吸窘迫综合征/膈肌超声/氧合指数/肺损伤评分/机械通气/脱机失败Key words
acute respiratory distress syndrome/diaphragmatic ultrasound/oxygenation index/lung injury prediction score/mechanical ventilation/weaning failure分类
医药卫生引用本文复制引用
王勇,惠培育..PaO2/FiO2及LIPS对急性呼吸窘迫综合征患者机械通气脱机失败的预测价值[J].中国现代医学杂志,2026,36(12):27-33,7.基金项目
四川省科技厅重点研发计划项目(2023YFS0700) （2023YFS0700）
