超声下膈肌收缩指数与腹部大手术后脱机成功率相关性分析  

Correlation between diaphragmatic contraction index and weaning success rate after major abdominal surgery

作　　者：张声[1] 张卫星[1] 林影芯[1] ZHANG Sheng;ZHANG Wei-xing;LIN Ying-xin(Department of Critical Care Medicine,Shenzhen Hospital,Peking University,Shenzhen 518000,Guangdong,China)

机构地区：[1]北京大学深圳医院重症医学科,广东深圳518000

出　　处：《生物医学工程与临床》2020年第3期257-261,共5页Biomedical Engineering and Clinical Medicine

摘　　要：目的研究超声下膈肌收缩指数与腹部大手术后脱机成功率的相关性。方法选择北京大学深圳医院2015年11月至2017年11月收治的腹部大手术患者130例,其中男性59例,女性71例;年龄40~71岁,平均年龄57.54岁;通气时间3~7 d,平均通气时间5.23 d。根据患者是否脱机成功分为2组(成功组、失败组),均65例。对比两组患者膈肌收缩指数,分析与脱机成功的相关性。结果两组患者在自主呼吸试验(SBT)0 min、10 min之间的膈肌移动度(DMM)(左侧、右侧)参数差异均无统计学意义(t=-0.112、0.480、0.753、1.036,P=0.911、0.632、0.453、0.302> 0.05),但成功组SBT 30 min参数明显低于失败组,差异有显著统计学意义(t=3.692、3.341,P=0.000、0.001 <0.01)。在SBT 0 min时两组患者浅快呼吸指数比较,差异无统计学意义(t=0.595,P=0.553> 0.05);而在SBT 10 min、30 min时成功组低于失败组,差异有显著统计学意义(t=3.700、5.896,P=0.000、0.000 <0.01)。SBT前,两组患者氧合指数差异无统计学意义(P> 0.05);SBT后,成功组氧合指数在各个时间段均高于失败组,差异有显著统计学意义(t=-3.506、-4.138、-8.291,P=0.001、0.000、0.000 <0.01);而两组患者左右侧的平静呼气末膈肌厚度比较,差异均无统计学意义(P> 0.05)。结论通过对腹部大手术患者实施超声下膈肌检测,DMM能够明确指导患者脱机结果,图像质量较高,值得应用。Objective To study the correlation between diaphragm contractility index and success rate of weaning surgery after major abdominal surgery. Methods From November 2015 to November 2017, a total of 130 patients underwent major abdominal surgery were enrolled, which included 59 males and 71 females, aged 40-71 years old with mean age of 57.54 years old, with ventilation time of 3-7 days and mean ventilation time of 5.23 days. According to success of weaning or not, all of them were divided into 2 groups(success group and failure group), with 65 patients in each group. The diaphragm contraction index of 2 groups was compared and the correlation with weaning success was analyzed. Results There was no significant difference in diaphragm muscle mobility(DMM)(left, right) between 0-minute and 10-minute during spontaneous breathing test(SBT) between 2 groups(t =-0.112, 0.480, 0.753, 1.036, P = 0.911, 0.632, 0.453, 0.302 > 0.05). However, SBT of successful group were significantly lower than those in failure group(t = 3.692, 3.341, P = 0.000, 0.001 < 0.01). There was no significant difference in shallow fast breathing index between 2 groups at SBT 0-minute(P > 0.05). However, SBT 10-minute and30-minute of success group was significantly lower than failure group(t = 3.700, 5.896, P = 0.000, 0.000 < 0.01). Before SBT,there was no significant difference in oxygenation index between 2 groups(P > 0.05). After SBT, oxygenation index of successful group was significantly higher than that of failure group at all time periods(t =-3.506,-4.138,-8.291, P = 0.001, 0.000,0.000 < 0.01). There was no statistical significance in thickness of end-expiratory diaphragm between 2 groups(P > 0.05). Con clusion It is demonstrated that DMM could clearly guide weaning result by ultrasonic diaphragm detection in patients with major abdominal surgery, which showed high image quality and is worthy of application.

关 键 词：超声 膈肌收缩 膈肌移动度 膈肌厚度 浅快呼吸指数 腹部大手术 脱机成功率 相关性 

分 类 号：R445.1[医药卫生—影像医学与核医学] R656[医药卫生—诊断学]