床旁膈肌超声技术诊断ICU获得性衰弱的临床研究  

Clinical study on application value of diaphragm ultrasound in diagnosis of intensive care unit-acquired weakness

作　　者：夏婧[1] 杨莉[1] 李美菊 刘晓雪 钱传云[1] Xia Jing;Yang Li;Li Mei-ju;Liu Xiao-xue;Qian Chuan-yun(Emergency Departmen,the Affiliated Hospital of Kunming Medical University,Kunming 650032,China)

机构地区：[1]昆明医科大学第一附属医院急诊科,云南昆明650032

出　　处：《中国急救医学》2019年第12期1154-1158,共5页Chinese Journal of Critical Care Medicine

基　　金：国家留学基金管理委员会"国家建设高水平大学公派研究生项目"(201608530178);云南省高层次卫生技术人才培养(后备人才)(H-201616)。

摘　　要：目的探讨床旁膈肌超声在ICU获得性衰弱(ICU-AW)早期诊断中的临床应用价值。方法选择2018年1月至2019年1月收住昆明医科大学第一附属医院急诊重症监护病房(EICU)的患者71例。按通气方式不同分为两组,机械通气组患者33例,非机械通气组患者38例。在患者入院后第1、3、7天,使用医学研究委员会肌力评分(MRC)对患者进行评分,同时应用床旁超声测定患者膈肌厚度(DT)、膈肌移动度(DE)、计算膈肌厚度分数(DTF),将数据进行统计学分析。结果机械通气患者的DTF随机械通气时间延长而减小(%:29.41±8.32,23.53±5.34,18.65±5.92),两两比较三组间差异有统计学意义(P<0.05);呼气末膈肌厚度(TEE)随机械通气时间延长变薄(cm:0.19±0.04,0.17±0.04,0.15±0.04),第1天和第7天比较差异有统计学意义(P<O.05),其余时间两两比较差异无统计学意义(P>0.05);利用DTF<16.30%预测及诊断患者ICU-AW发生的受试者工作特征(ROC)曲线下面积(AUC)为0.84,敏感度为0.86,特异度为0.80(P=0.001);利用TEE<0.17 cm变化预测及诊断ICU-AW的AUC为0.80,敏感度为0.71,特异度为0.74(P=0.019).结论对于ICU中机械通气患者,可以应用床旁膈肌超声对ICU-AW做出早期的预测及诊断,其中DTF是较为理想的指标。Objective To investigate the clinical application value of diaphragm ultrasound in the diagnosis of intensive care unit-Acquired weakness(ICU-AW).Methods 71 patients were included during January 2018 to January 2019 in EICU of the affiliated teaching hospital of Kunming Medical University.The patients were divided into 2 groups according to ventilation mode:33 patients in mechanical ventilation group;38 patients in the non-mechanical ventilation group.Respectively,bedside ultrasound was performed to measure diaphragmatic thickness(DT),diaphragmatic excursion(DE),and diaphragm thickening fraction(DTF)on the first,third and seventh day after admission.Meanwhile the MRC score was also recorded.Results Comparing diaphragmatic measurements of different time points(DI vs.D3、D1 vs.D7、D3 vs.D7),diaphragmatic thickening fraction(DTF)decreased with the prolongation of mechanical ventilation time(29.41±8.32)%,(23.53±5.34)%,(18.65±5.92)%.There were all significant differences(P<0.05).End-expiratory diaphragmatic thickness decreased with the prolongation of mechanical ventilation time(0.19±0.04)cm,(0.17±0.04)cm,(0.15±0.04)cm,there was significant differences between the 1st day vs the 7th day(P<0.05).DTF<16.30%as an indicate in the diagnosis of ICU-AW for,the area under the curve of ROC(AUC)was 0.84,sensitivity was 0.86,specificity was 0.80(P=0.001);TEE<0.17 cm to predict the ICU-AW,area under the curve of ROC(AUC)was 0.80,sensitivity was 0.71,specificity was 0.74(P=0.019).Conclusion Diaphragm ultrasound is a good predictor to access ICU-AW in ventilated patients in ICU.

关 键 词：ICU获得性衰弱(ICU-AW) 膈肌超声 膈肌功能障碍 膈肌厚度分数(DTF) 

分 类 号：R459.7[医药卫生—急诊医学]