肺部超声评分对腹腔感染机械通气患者脱机结局的预测价值  

Predictive value of lung ultrasound score on weaning outcome in patients with intro-abdominal infection undergoing mechanical ventilation

作　　者：顾彩虹 谢永鹏[2] 郑涛[1] 任华建 王革非 任建安 Gu Caihong;Xie Yongpeng;Zheng Tao;Ren Huajian;Wang Gefei;Ren Jian'an(Research Institute of General Surgery,Jinling Hospital of Nanjing Medical University(East War Zone Hospital),Nanjing 210002,Jiangsu,China;Department of Intensive Care Unit,the First People's Hospital of Lianyungang,Lianyungang 222000,Jiangsu,China)

机构地区：[1]南京医科大学附属金陵临床医学院(东部战区总医院)普外科研究所,210002 [2]连云港市第一人民医院重症医学科,222000

出　　处：《中华危重病急救医学》2020年第1期94-98,共5页Chinese Critical Care Medicine

基　　金：中国博士后科学基金(2016M602982);江苏省医学杰出人才项目(JCRCB2016006);江苏省连云港市科技局社会发展基金(SH1601)。

摘　　要：目的评价肺部超声评分(LUS)对腹腔感染(IAI)机械通气患者脱机结局的预测价值。方法选择2018年1月至12月东部战区总医院普外科研究所和连云港市第一人民医院重症医学科收治的IAI机械通气患者,符合脱机标准者进入脱机流程,脱机过程包括自主呼吸试验(SBT)和拔管。根据SBT是否成功(SBT成功定义为能通过120 min的SBT)分为SBT成功组和SBT失败组,比较两组患者SBT前后的LUS评分;SBT成功组患者给予拔管,根据拔管是否成功(拔管成功定义为拔管后48 h内无需再插管进行有创通气)分为拔管成功组和拔管失败组进行亚组分析,比较拔管前(SBT结束时)和拔管后(拔管成功组为拔管后48 h,拔管失败组为再插管前)LUS评分。绘制受试者工作特征曲线(ROC),评估SBT前LUS评分对SBT失败的预测价值,以及拔管前LUS评分对拔管失败的预测价值。结果研究期间共收治76例IAI机械通气患者,排除机械通气时间不足48 h、重度慢性阻塞性肺疾病(COPD)、气管切开和自动出院者23例,最终53例纳入分析。53例患者中SBT成功44例,失败9例;44例SBT成功患者中拔管成功23例,失败21例。SBT失败组患者SBT前后LUS评分均明显高于SBT成功组(分:SBT前为13.22±1.99比10.79±1.64,t=-3.911,P=0.000;SBT后为19.00±1.12比13.41±1.86,t=-8.665,P=0.000)。ROC曲线分析显示,SBT前LUS评分预测SBT失败的ROC曲线下面积(AUC)为0.82〔95%可信区间(95%CI)为0.67~0.98,P=0.002〕;当最佳截断值为12.5分时,敏感度为66.7%,特异度为84.1%。亚组分析显示,SBT成功患者中拔管失败组拔管前后LUS评分均明显高于拔管成功组(分:拔管前为14.19±1.60比12.69±1.81,t=-2.881,P=0.006;拔管后为16.42±1.59比12.78±1.54,t=-7.710,P=0.000)。ROC曲线分析显示,拔管前LUS评分预测拔管失败的AUC为0.81(95%CI为0.69~0.92,P=0.000);当最佳截断值为13.5分时,敏感度为80.0%,特异度为65.2%。结论LUS评分可以有效预测IAI机械通气患者的SBT结Objective To evaluate the value of lung ultrasound score(LUS)on predicting weaning outcome in patients with intro-abdominal infection(IAI)undergoing mechanical ventilation.Methods Patients with IAI undergoing mechanical ventilation admitted to Research Institute of General Surgery of East War Zone Hospital and intensive care unit(ICU)of the First People's Hospital of Lianyungang from January to December in 2018 were included.The patients who satisfied weaning criteria were enrolled in the weaning process,which included spontaneous breathing trial(SBT)and extubation.They were divided into SBT success group and SBT failure group according to whether passed 120-minute SBT or not.LUS scores before and after SBT were compared between the two groups.The patients in the SBT success group were extubated,and they were divided into successful extubation group and failed extubation group for sub-group analysis according to whether re-intubation was needed in 48 hours after extubation.LUS score before extubation(at the end of SBT)and 48 hours after extubation(48 hours after extubation in the successful extubation group or before re-intubation in the failed extubation group)were compared.The receiver operating characteristic(ROC)curve was drawn to evaluate the predictive value of LUS score before SBT for SBT failure and LUS score before extubation for the failure.Results A total of 76 patients with IAI undergoing mechanical ventilation were included.Twenty-three patients had duration of mechanical ventilation less than 48 hours,severe chronic obstructive pulmonary disease(COPD),tracheotomy or automatic discharge were excluded,and 53 patients were enrolled.SBT was failed in 9 patients,and successfully performed in 44 patients,of whom 23 patients with successful extubation,and 21 with failed extubation.The LUS scores before and after SBT in the SBT failure group were significantly higher than those in the SBT success group(before SBT:13.22±1.99 vs.10.79±1.64,t=-3.911,P=0.000;after SBT:19.00±1.12 vs.13.41±1.86,t=-8.665,P=0.0

关 键 词：肺部超声评分 腹腔感染 自主呼吸试验 拔管 

分 类 号：R563[医药卫生—呼吸系统]