超声监测膈肌运动指标对机械通气撤机的指导价值  

Value of the diaphragm movement index tested by ultrosonography for ventilation weaning

作　　者：樊麦英[1] 罗杰英 文辉[1] 宁凤玲 高敏 韩小彤[1] Fan Maiying;Luo Jieying;Wen Hui;Ning Fengling;Gao Min;Han Xiaotong(Department of Emergency Medicine,Hunan Provincial People's Hospital (the First Affiliated Hospital of Hunan Normal University),Hunan Key Laboratory of Critical and Critical Metabolomics,Changsha 410005,Hunan,China)

机构地区：[1]湖南省人民医院(湖南师范大学第一附属医院)急诊科,急危重症代谢组学湖南省重点实验室,湖南长沙410005

出　　处：《中华危重病急救医学》2018年第11期1041-1045,共5页Chinese Critical Care Medicine

基　　金：湖南省卫生计生委科研计划项目(B20180536).

摘　　要：目的通过超声评估机械通气撤机患者的膈肌运动指标,探讨膈肌超声指标对撤机的指导价值。方法选择2017年9月至2018年2月在湖南省人民医院急诊重症加强治疗病房(EICU)进行有创机械通气至少48h的40例患者,采用低水平压力支持通气(PSV)进行自主呼吸试验(SBT),在SBT 1h内采用床旁M型超声评估患者的膈肌运动指标,包括膈肌位移、膈肌浅快呼吸指数(D—RSBI),应用呼吸机测量浅快呼吸指数(RSBI),对符合临床撤机标准者进行撤机。根据撤机成功与否将患者分为撤机成功组和撤机失败组。采用受试者工作特征曲线(ROC)评价各项指标对撤机失败的预测价值。结果40例患者均纳入最终分析,其中撤机成功组28例,撤机失败组12例。撤机失败组膈肌位移明显小于撤机成功组(mm:9.56±2.13比13.66±4.10,P<0.01),D—RSBI和RSBI明显大于撤机成功阻[D—RSBI(次·min^-1·mm^-1):2.06±0.68比1.44±0.66,RSBI(次·min^-1·L^-1):61.70±25.00比44.91±14.51,均P<0.05]。膈肌位移、D—RSBI、RSBI的ROC曲线下面积(AUC)分别为0.830、0.851和0.711,以膈肌位移和D—RSBI的预测价值较大。当膈肌位移的最佳临界值为11.15mm时,预测撤机失败的敏感度为83.3%,特异度为71.4%;当D—RSBI的最佳临界值为1.42次·min^-1·mm^-1时,预测撤机失败的敏感度为91.7%,特异度为82.1%。结论膈肌超声指标的膈肌位移及D—RSBI可以准确预测撤机失败,其在指导撤机上优于传统的RSBI。Objective To evaluate the diaphragm movement index of mechanical ventilation weaning patients by ultrosonography,and to explore its value for weaning.Methods Forty patients undergoing invasive mechanical ventilation for at least 48 hours admitted to emergency intensive care unit (EICU)of Hunan Provincial People's Hospital from September 2017 to February 2018 were enrolled.Low level pressure support ventilation (PSV) was used for spontaneous breathing test (SBT),and bedside M-mode ultrasonography was used to assess the diaphragm movement index of the patient within 1 hour of SBT,including the excursion of the diaphragm,diaphragmatic-rapid shallow breathing index (D-RSBI).The rapid shallow breathing index (RSBI)was measured by ventilator.The patients who met the clinical weaning criteria were weaned.According to the success or failure of the weaning,the patients were divided into the successful weaning group and the failure weaning group.The receiver operating characteristic (ROC) curve was used to evaluate the predictive value of each indicator to the failure of the weaning.Results A total of 40 patients were enrolled in the final analysis,including 28 patients in the successful weaning group and 12 patients in the failure weaning group.The excursion of the diaphragm in the failure weaning group was significantly less than that in the successful weaning group (mm:9.56±2.13vs.13.66±4.10,P <0.01),and the D-RSBI and RSBI were significantly higher than those in the successful weaning group [D-RSBI (times·min^-1·mm^-1):2.06±0.68 vs.1.44±0.66,RSBI (times·min^-1·L^-1):61.70±25.00 vs.44.91±14.51,both P <0.05].The area under the ROC curve (AUC) of diaphragm displacement,D-RSBI,and RSBI was 0.830,0.851 and 0.711,respectively,and the predicted value of diaphragm excursion and D-RSBI was higher.When the optimal critical value of diaphragmatic excursion was 11.15mm, the sensitivity of predicting weaning failure was 83.3%,the specificity was 71.4%;when the optimal critical value of D-RSBI was 1.42 times ·min^-1·mm^-

关 键 词：超声 膈肌运动 撤机指标 

分 类 号：R459.7[医药卫生—急诊医学]