内科

目的探讨肺部高频超声评分联合氧合指数预测机械通气患儿撤机结局的价值。方法回顾性分析116例机械通气患儿的临床资料，根据撤机结局将其分为成功组（n=106）和失败组（n=10）。比较两组患儿撤机前2 h内的肺部高频超声评分和氧合指数；应用多因素logistic回归模型分析上述两项指标对机械通气患儿撤机结局的影响；绘制受试者操作特征（ROC）曲线评价肺部高频超声评分联合氧合指数预测机械通气患儿撤机结局的价值。结果成功组患儿肺部高频超声评分低于失败组，氧合指数高于失败组（均P<0.05）。多因素logistic回归分析结果显示，肺部高频超声评分（OR=1.650，95%CI：1.188～2.293）、氧合指数（OR=0.976，95%CI：0.956～0.997）均是机械通气患儿撤机结局的独立影响因素（均P<0.05）；在此基础上构建的联合预测模型公式为Logit（P）=-4.557+0.501×肺部高频超声评分-0.024×氧合指数。ROC曲线分析结果显示，肺部高频超声评分联合氧合指数预测模型的ROC曲线下面积为0.825（95%CI：0.697～0.954），敏感度为0.600，特异度为0.925，Youden指数为0.525。结论肺部高频超声评分和氧合指数均是机械通气患儿撤机结局的独立影响因素，基于这两项指标构建的联合预测模型对撤机结局具有较好的预测价值。

Objective To explore the value of lung high-frequency ultrasound score combined with oxygenation index in predicting weaning outcomes in mechanically ventilated children. Methods The clinical data of 116 mechanically ventilated children were retrospectively analyzed, and they were divided into the success group (n=106) or the failure group (n=10) according to the weaning outcomes. The lung high-frequency ultrasound score and oxygenation index within 2 hours before weaning were compared between the two groups. A multivariate logistic regression model was used to analyze the impacts of the above two indicators on weaning outcomes in mechanically ventilated children. Receiver operating characteristic (ROC) curves were plotted to evaluate the value of lung high-frequency ultrasound score combined with oxygenation index in predicting weaning outcomes in mechanically ventilated children. Results The lung high-frequency ultrasound score in the success group was lower than that in the failure group, while the oxygenation index was higher than that in the failure group (all P<0.05). Results of multivariate logistic regression analysis showed that lung high-frequency ultrasound score (OR=1.650, 95%CI: 1.188-2.293) and oxygenation index (OR=0.976, 95%CI: 0.956-0.997) were independent influencing factors for weaning outcomes in mechanically ventilated children (all P<0.05), based on which a prediction model formula was constructed: Logit(P)=-4.557 + 0.501 × lung high-frequency ultrasound score - 0.024 × oxygenation index. Results of ROC curve analysis showed that the area under the ROC curve of the prediction model of lung high-frequency ultrasound score combined with oxygenation index was 0.825 (95%CI: 0.697-0.954), with a sensitivity of 0.600, a specificity of 0.925, and a Youden index of 0.525. Conclusion Both lung high-frequency ultrasound score and oxygenation index are independent influencing factors for weaning outcomes in mechanically ventilated children. The combined prediction model based on these two indicators has good predictive value for weaning outcomes.