超声评估右心功能对机械通气患者撤机结果的预测价值  

Predictive Value of Echocardiographic Assessment of the Right Ventricular Function on Mechanical Ventilation Weaning

作　　者：窦志敏[1] 陈启明[1] 林庆玲[1] 李斌[1] 刘健[1] DOU Zhimin;CHEN Qiming;LIN Qingling;LI Bin;LIU Jian(Department of Critical Care Medicine,the First Hospital of Lanzhou University,Lanzhou 730000,China)

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：《中国医学影像学杂志》2019年第10期761-765,共5页Chinese Journal of Medical Imaging

基　　金：甘肃省自然科学基金(1308RJZA240)

摘　　要：目的探讨床旁超声评估右心功能对机械通气患者撤机结果的预测价值。资料与方法纳入82例机械通气患者,采用T管模式进行自主呼吸试验(SBT),以拔管后自主呼吸时间超过48 h为撤机成功。在SBT开始10 min后或SBT失败前测量患者的右心室功能指标,包括三尖瓣环根部侧壁收缩期位移(TAPSE)、三尖瓣舒张早期血流峰速度和舒张晚期血流峰速度比值(E/A)、右心室舒张末期面积/左心室舒张末期面积比(RVarea/LVarea)以及呼气末下腔静脉内径(dIVC)。比较撤机成功组(n=61)和撤机失败组(n=21)患者的右心功能指标,并评价各心功能指标对撤机结果的预测价值。结果撤机失败组患者中心静脉压高于撤机成功组[(10.0±3.2)mmHg比(7.2±2.8)mmHg,P<0.05];撤机成功组TAPSE高于撤机失败组[(24.70±6.96)mm比(13.33±6.42)mm,P<0.01],E/A比值也高于撤机失败组(1.50±0.49比1.08±0.51,P<0.01),而RVarea/LVarea和dIVC均低于撤机失败组(P均<0.05)。TAPSE和三尖瓣E/A预测撤机结果的受试者工作特征曲线下面积分别为0.88和0.76。结论SBT前超声评估机械通气患者的右心功能可以预测其撤机结果,并可指导其液体管理。Purpose To investigate the predictive value of bedside ultrasound in assessing right ventricular function on mechanical ventilation weaning.Materials and Methods Eighty-two patients with mechanical ventilation were included and subjected to the spontaneous breathing trial(SBT)by T-tube mode,and the spontaneous breathing time exceeding 48 h after extubation represented the success of weaning.The right ventricular function indices of the patient were measured after SBT started 10 min or before SBT failed,including the tricuspid annular plane systolic excursion(TAPSE),the ratio of peak tricuspid flow velocity of the early rapid filling wave to peak tricuspid flow velocity of the late rapid filling wave(E/A),the ratio of the right ventricular end diastolic area to the left ventricular end diastolic area(RVarea/LVarea)and the inferior vena cava diameter(dIVC).The right cardiac function indices were compared between the success group(n=61)and the failure group(n=21),and the predictive values of the cardiac function indices for the results of the weaning were evaluated.Results The central venous pressure of patients in the failure group was higher than that in the success group[(10.0±3.2)mmHg vs.(7.2±2.8)mmHg,P<0.05];the TAPSE of patients in the success group was higher than that in the failure group[(24.70±6.96)mm vs.(13.33±6.42)mm,P<0.01],and the E/A ratio was also higher than that in the failure group(1.50±0.49 vs.1.08±0.51,P<0.01).However,the RVarea/LVarea and dIVC in the success group were all lower than those in the failure group(P<0.05).The areas under the receiver operating characteristic curve of predictive weaning result of TAPSE and tricuspid E/A were 0.88 and 0.76,respectively.Conclusion Echocardiographic evaluation of the right ventricular function in patients with mechanical ventilation before SBT could predict the mechanical ventilation weaning and guide its fluid management.

关 键 词：呼吸 人工 通气机撤除法 超声心动描记术 多普勒 彩色 心室功能 右 

分 类 号：R445.1[医药卫生—影像医学与核医学]