膈肌浅快呼吸指数对机械通气慢性阻塞性肺疾病患者撤机的预测价值  

Predictive value of diaphragm rapid shallow breathing index in weaning from mechanical ventilation in patients with chronic obstructive pulmonary disease

作　　者：窦志敏[1] 李红[1] 朱磊[1] 陈启明[1] 李斌[1] 刘健[1] DOU Zhimin, LI Hong, ZHU Lei, CHEN Qiming, LI Bin, LIU Jian(Department of Critical Care Medicine, The First Hospital of Lanzhou University, Lanzhou, Gansu 730000, P. R. Chin)

机构地区：[1]兰州大学第一医院重症医学科,甘肃兰州730000

出　　处：《中国呼吸与危重监护杂志》2018年第2期124-127,共4页Chinese Journal of Respiratory and Critical Care Medicine

基　　金：甘肃省自然科学基金(1308RJZA240)

摘　　要：目的探讨膈肌浅快呼吸指数(diaphragm rapid shallow breathing index,D-RBSI)对机械通气慢性阻塞性肺疾病(简称慢阻肺)患者撤机结果的预测价值。方法纳入2016年3月至2017年3月我院重症医学科收治的76例机械通气慢阻肺患者。患者通过撤机筛查后以持续气道正压通气模式进行自主呼吸试验(spontaneous breathing test,SBT),SBT开始后10 min或SBT失败时记录患者的呼吸频率(respiratory rate,RR)和潮气量,并利用床旁超声测量患者的膈肌活动度(diaphragmatic displacement,DD)。以RR和DD的比值(RR/DD)计算D-RBSI,通过受试者工作特征(receiver operating characteristic,ROC)曲线分析D-RBSI对机械通气慢阻肺患者撤机结果的预测价值。结果共有28例患者撤机失败。成功组和失败组患者的年龄和急性生理学和慢性健康状况评分系统Ⅱ评分无明显差异。成功组患者DD大于失败组[(22±6)mm比(13±5)mm,P<0.001)],RBSI和D-RBSI均低于失败组[RBSI:(40±14)次/(min·L)比(52±20)次/(min·L),P=0.003;D-RBSI:(0.95±0.51)次/(min·mm)比(1.79±0.83)次/(min·mm),P<0.001)]。两组患者的RBSI和D-RBSI之间相关性良好(R2=0.778,P<0.001)。D-RBSI对患者撤机结果预测的ROC曲线下面积高于RBSI[(0.85比0.75,P<0.001)],D-RBSI>1.13次/(min·mm)预测撤机失败的敏感性为0.82,特异性为0.81。结论超声监测机械通气慢阻肺患者SBT时D-RBSI可有效判断其撤机结果。ObjectiveTo investigate the predictive value of diaphragm rapid shallow breathing index （D-RBSI） in weaning from mechanical ventilation in patients with chronic obstructive pulmonary disease （COPD）.MethodsSeventy-six patients with COPD who were undergoing mechanical ventilation were enrolled in department of critical care medicine of our hospital from March 2016 to March 2017. The patient underwent spontaneous breathing test （SBT） using CPAP mode after weaning screening. When the SBT had started 10 min or the SBT failed, the patients＇ respiratory rate （RR） and tidal volume were recorded, and the diaphragmatic displacement （DD） of patients was measured by bedside ultrasound. The ratio of RR to DD （RR/DD） was calculated as D-RBSI, and the predictive value of D-RBSI on weaning results in mechanically ventilated patients with COPD was analyzed by receiver operating characteristic （ROC） curve.ResultsTwenty-eight patients failed weaning procedure. There were no significant differences in age and acute physiology and chronic health evaluation II scores between the successful group and the failed group. The DD of the patients in the successful group was greater than that of the failed group [（22±6） mm vs. （13±5） mm, P〈0.001]. RBSI and D-RBSI of the successful group were lower than those of the failure group [RBSI： （40±14） breaths/（min·L）vs. （52±20） breaths/（min·L）, P=0.003; D-RBSI： （0.95±0.51） breaths/（min·mm） vs. （1.79±0.83） breaths/（min·mm）, P〈0.001）]. There was a good correlation between the RBSI and D-RBSI in the two groups （R2=0.778, P〈0.001）. The area under the ROC curve predicted the weaning result by D-RBSI was higher than RBSI （0.85vs. 0.75, P〈0 001=＂＂ the=＂＂ cutoff=＂＂ value=＂＂ of=＂＂ d-rbsi=＂＂〉1.13 breaths/（min·mm） to predict weaning failure had a sensitivity of 0.82, and a specificity of 0.81.ConclusionThe rapid shallow breathing index of diaphragm can be effectively used to predict

关 键 词：慢性阻塞性肺疾病 呼吸浅快指数 机械通气 撤机 

分 类 号：R563.9[医药卫生—呼吸系统]