超声膈肌功能评估在指导COPD机械通气患者撤机中的临床价值研究  

Study on clinical significance of ultrasonic diaphragm function evaluation in patients with COPD under mechanical ventilation

作　　者：伍春燕[1] 黄宏[2] 朱辉严[3] 刘滨[1] 莫建伟[1] 邹宇君[1] 叶先钦 钟穂斌 

机构地区：[1]广东省农垦中心医院ICU,广东湛江524002 [2]广东省农垦中心医院超声科,广东湛江524002 [3]广东省农垦中心医院放射科,广东湛江524002

出　　处：《临床和实验医学杂志》2016年第12期1203-1206,共4页Journal of Clinical and Experimental Medicine

基　　金：湛江市非资助科技攻关计划项目(编号:2015B101)

摘　　要：目的研究超声膈肌功能评估在指导慢性阻塞性肺疾病(COPD)机械通气病患撤机中的临床应用价值。方法收集2014年2月1日至2015年12月31日在ICU住院符合COPD临床诊断且需要机械通气的病例45例,根据撤机成功与否分为撤机成功组19例(观察组)与撤机失败组26例(对照组)。测定两组自主呼吸试验(SBT)中0 min、5min以及30 min的右侧膈肌位移(DE)、膈肌收缩速度,然后分析以上膈肌功能指标对撤机成功的预测价值。结果两组DE在SBT中逐渐升高,并且观察组DE在SBT 0 min、5 min以及30 min时明显低于对照组。SBT中DE对撤机成功的灵敏度、准确度都非常高,并且在SBT 30 min时DE预测撤机成功的AUC值为0.745。其中DE>1.14 mm为临界值时,其预测的撤机成功的灵敏度、特异性、准确度分别为100.00%、92.31%和95.56%。两组膈肌收缩速度在SBT中逐渐升高,并且对照组膈肌收缩速度在SBT 0 min、5 min以及30 min的膈肌收缩速度明显高于对照组SBT中膈肌收缩速度对撤机成功的灵敏度、准确度都非常高,并且在SBT 30 min时DE预测撤机成功的AUC值为0.861。其中膈肌收缩速度≤1.46 cm/s为临界值时,其预测的撤机成功的灵敏度、特异度、准确度分别为68.42%、92.31%和95.56%。结论超声膈肌功能相关指标中的DE、膈肌收缩速度对COPD机械通气病患撤机具有较好的预测价值,其中DE>1.14 mm、膈肌收缩速度≤1.46 cm/s为临界值时具有更高的特异度、灵敏度和准确度。超声膈肌功能评估在临床上具有良好的预测效果,值得推广应用。Objective To explore the clinical sifnificance of application of ultrasonic diaphragm muscle function evaluation in patients with chronic obstructive pulmonary disease（ COPD） under mechanical ventilation. Methods A total of 45 patients with COPD needing mechanical ventilation in ICU of this hospital during February 1,2014 to December 31,2015 were allocated in this study,they were divided into observaion group（ 19 cases） and control group（ 26 cases） according to successful weaning mechanical ventiliation or not. The spontaneous breathing test（ SBT） in 0 min,5 min and 30 min of the right diaphragm displacement（ DE） and diaphragm contraction rate were measured in patients of these 2 groups,then above predictive value of diaphragmatic function for successful weaning had been analyzed. Results The diaphragm displacement（ DE） in SBT of pateitnts in these 2 group were gradually increased,and the diagphragm displacements（ DE） in SBT 0 min,5 min and30 min in control group were significantly lower than those of control group. The sensitivity and accuracy of successful weaning is very high,and the SBT30 min DE predictive value of successful weaning AUC value was 0. 861,in which DE 1. 14 mm was the critical value,the sensitivity,specificity and accuracy in prediction of successful weaning were 100. 00%,92. 31% and 95. 56%. The speed of diaphragmatic contraction in SBT was gradually increased,and the speed of diaphragmatic contraction in SBT in 0 min,5 min and 30 min in control group was significantly higher than that of control sensitivity of SBT group in the diaphragm muscle contraction rate of successful weaning and accuracy were very high,and in the SBT 30 min DE pre measured successful weaning of AUC value was 0. 861,the speed of diaphragmatic contractile was less than or equal to 1. 46 cm / s as critical value and the sensitivity,specificity and accuracy in prediction of successful weaning were 68. 42%,92. 31% and 95. 56% respectively. Conclusion Ultrasound diaphragmatic function related indi

关 键 词：COPD 机械通气 超声 膈肌功能 

分 类 号：R563.9[医药卫生—呼吸系统]