膈肌超声指标对慢性阻塞性肺疾病急性加重患者无创通气治疗效果的预测价值  

Predictive value of diaphragmatic ultrasound indexes for efficiency of noninvasive ventilation in patients with acute exacerbation of chronic obstructive pulmonary disease

作　　者：孙勇波 俞南臣 杜旭东 SUN Yongbo;YU Nanchen;DU Xudong(Department of Emergency Medicine,Fenghua District People’s Hospital,Ningbo 315500,China)

机构地区：[1]宁波市奉化区人民医院医共体急诊科,315500

出　　处：《浙江医学》2020年第13期1381-1385,共5页Zhejiang Medical Journal

摘　　要：目的探讨膈肌超声指标对慢性阻塞性肺疾病急性加重(AECOPD)患者无创通气治疗效果的预测价值。方法选取2018年7月至2019年9月在宁波市奉化区人民医院行无创通气治疗的69例AECOPD患者为研究对象,其中无创通气治疗成功39例,失败30例。比较无创通气成功与失败患者的临床资料,采用多因素logistic回归模型分析AECOPD患者无创通气治疗效果独立预测指标,同时绘制ROC曲线评估这些指标对无创通气治疗效果的预测效能。结果无创通气成功与失败患者在性别、年龄、BMI、合并症、收缩压、平均动脉压、心率、血氧饱和度、呼吸频率、PaO2、氧合指数(PaO2/FiO2)、吸气时间(TI)比较,差异均无统计学意义(均P>0.05);无创通气成功患者住院时间、PaCO2均低于治疗失败患者(均P<0.05),酸碱度(pH)、膈肌增厚分数(DTF)、膈肌活动度(DE)、膈肌移动时间(E-T)指数均明显高于治疗失败患者(均P<0.05)。pH(OR=2.218,95%CI:1.016~3.419,P<0.05)、PaCO2(OR=2.162,95%CI:1.062~3.261,P<0.05)、DTF(OR=3.132,95%CI:1.991~4.272,P<0.05)是无创通气治疗效果的独立预测指标。pH、PaCO2、DTF预测AECOPD患者无创通气治疗效果的AUC分别为0.792、0.772、0.856,均有良好的预测效能;其中DTF的预测效能最高,其灵敏度、特异度、最佳截断值分别为0.77、0.70、21.50%。结论DTF能较好预测AECOPD患者无创通气治疗效果。Objective To assess the predictive value of diaphragmatic ultrasound indexes for efficiency of noninvasive ventilation in patients with acute exacerbation of chronic obstructive pulmonary disease(AECOPD).Methods A total of 69 patients with AECOPD who underwent noninvasive ventilation in our hospital from July 2018 to September 2019 were enrolled in the study,among whom the noninvasive ventilation was successful in 39 cases and failed in 30 cases.The clinical data were compared between patients with noninvasive ventilation success and failure,multivariate logistic regression model was used to analyze the independent predictive indexes of noninvasive ventilation efficiency in AECOPD patients,and ROC curve was used to evaluate the predictive value of these indexes.Results There were no significant differences in gender,age,BMI,comorbidities,systolic blood pressure,mean arterial pressure,heart rate,blood oxygen saturation,respiratory rate,PaO2,oxygenation index(PaO2/FiO2),inspiratory time(TI)between patients with success and failure of noninvasive ventilation(all P>0.05).The length of hospital stay was shorter,the PaCO2 was lower,and the pH,diaphragm thickening score(DTF),diaphragm activity(DE),and diaphragm movement time(ET)were all significant higher in patients with successful noninvasive ventilation than those with noninvasive ventilation failure(all P<0.05).Multivariate logistic regression showed that pH(OR=2.218,95%CI:1.016-3.419,P<0.05),PaCO2(OR=2.162,95%CI:1.062-3.261,P<0.05),DTF(OR=3.132,95%CI:1.91-4.272,P<0.05)were independent predictors for noninvasive ventilation treatment.The area under the curve(AUC)of pH,PaCO2,DTF predicting the effect of noninvasive ventilation in AECOPD patients were 0.792,0.772,and 0.856,respectively.Among them,DTF had the highest prediction efficiency,and its sensitivity and specificity were 0.77 and 0.70 when the cutoff value was 21.50%.Conclusion Ultrasound parameter diaphramatic thickening fraction can better predict the effect of noninvasive ventilation treatment in AECOPD pati

关 键 词：慢性阻塞性肺疾病急性加重 膈肌超声 膈肌增厚分数 膈肌活动度 无创通气 

分 类 号：R563.9[医药卫生—呼吸系统]