文章摘要
综合脱机指数联合血清hsCRP/ALB、eNOS对重型颅脑损伤机械通气患者撤机失败的预测价值
The predictive value of integrative weaning index combined with serum hsCRP/ALB and eNOS for weaning failure in patients with severe traumatic brain injury undergoing mechanical ventilation
投稿时间：2025-12-26  修订日期：2026-08-05
DOI：
中文关键词: 综合脱机指数  血清超敏C反应蛋白/血清白蛋白  内皮型一氧化氮合酶  重型颅脑损伤  机械通气  撤机失败
英文关键词: integrative weaning index  serum hypersensitive C-reactive protein/serum albumin  endothelial nitric oxide synthase  severe traumatic brain injury  mechanical ventilation  weaning failure
基金项目:2024年度青岛市医疗卫生科研项目(NO:2024-WJKY101)
作者单位邮编
张婷婷* 青岛市胶州中心医院 266300
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中文摘要:
      【】? 目的? 探讨综合脱机指数(IWI)联合血清超敏C反应蛋白/血清白蛋白(hsCRP/ALB)、内皮型一氧化氮合酶(eNOS)对重型颅脑损伤(sTBI)机械通气患者撤机失败的预测价值。方法? 选取2022年1月至2025年8月本院收治的112例行机械通气的sTBI患者为研究对象,根据撤机结局将其分为撤机失败组(n=41)和撤机成功组(n=71)。相对危险度分析评估不同IWI及血清hsCRP/ALB、eNOS水平对sTBI机械通气患者撤机失败的影响。ROC曲线评估IWI及血清hsCRP/ALB、eNOS对sTBI机械通气患者撤机失败的预测价值。经Bootstrap重抽样进行预测模型内部验证,Hosmer-Lemeshow检验评估拟合优度。结果? 撤机失败组IWI及GCS评分显著低于撤机成功组,血清hsCRP/ALB、eNOS水平、机械通气时间及APACHE II评分显著高于撤机成功组(P＜0.05)。相对危险度分析显示,IWI低水平sTBI机械通气患者发生撤机失败的风险是高水平的2.045倍(95%CI:1.144-3.656),hsCRP/ALB、eNOS高水平sTBI机械通气患者发生撤机失败的风险分别是其低水平的1.867、2.094倍(95%CI:1.085-3.213,1.195-3.670)。ROC结果显示,IWI及血清hsCRP/ALB、eNOS单独预测sTBI机械通气患者撤机失败的AUC为0.801、0.796、0.799；联合预测的AUC为0.928,显著优于单一指标(Z联合-IWI=3.346,P=0.001,Z联合-hsCRP/ALB=3.455,P=0.001,Z联合-eNOS=2.854,P=0.004)。Bootstrap内部验证显示,ROC模型校准性能良好,Hosmer-Lemeshow检验结果表明模型拟合优度良好(χ2=3.761,自由度=8,P=0.878)。结论? IWI联合血清hsCRP/ALB、eNOS对sTBI机械通气患者撤机失败有良好的预测价值。
英文摘要:
      Objective: To explore the predictive value of integrative weaning index (IWI) combined with serum hypersensitive C-reactive protein/serum albumin (hsCRP/ALB) and endothelial nitric oxide synthase (eNOS) for weaning failure in patients with severe traumatic brain injury (sTBI) undergoing mechanical ventilation. Methods: A total of 112 sTBI patients who underwent mechanical ventilation and were admitted to our hospital from January 2022 to August 2025 were served as the research subjects. They were assigned into the weaning failure group (n=41) and the successful weaning group (n=71) according to the weaning outcomes. Relative risk analysis was used to evaluate the impact of different IWI and serum hsCRP/ALB and eNOS levels on the failure of weaning in sTBI patients with mechanical ventilation. ROC curve was used to evaluate the predictive value of IWI and serum hsCRP/ALB, eNOS for weaning failure in sTBI patients with mechanical ventilation. Bootstrap resampling was used for internal validation of the prediction model, and the Hosmer-Lemeshow test was used to evaluate the goodness of fit. Results: The weaning failure group had prominently lower IWI and GCS score than the successful weaning group, and prominently higher serum hsCRP/ALB, eNOS levels, mechanical ventilation time, and APACHE II score than the successful weaning group (P < 0.05). Relative risk analysis showed that the risk of weaning failure in mechanical ventilation patients with low-level sTBI on IWI was 2.045 times that of high-level patients (95%CI: 1.144-3.656), and the risk of weaning failure in sTBI patients with high levels of hsCRP/ALB and eNOS was 1.867 and 2.094 times that of low levels, respectively (95%CI: 1.085-3.213, 1.195-3.670). ROC results showed that the AUC of IWI and serum hsCRP/ALB, eNOS alone for predicting weaning failure in sTBI patients with mechanical ventilation was 0.801, 0.796, and 0.799, respectively, the AUC of the combined prediction was 0.928, which was prominently better than that of a single indicator (Z combination-IWI=3.346, P=0.001, Z combination-hsCRP/ALB=3.455, P=0.001, Z combination-eNOS=2.854, P=0.004). Internal validation of Bootstrap showed that the ROC model had good calibration performance, and the Hosmer-Lemeshow test results indicated that the model had good goodness of fit (χ2=3.761, degrees of freedom =8, P=0.878). Conclusion: IWI combined with serum hsCRP/ALB and eNOS has a good predictive value for weaning failure in sTBI patients with mechanical ventilation.
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