膈肌浅快呼吸指数在腹部脓毒症患者机械通气撤机中的预测价值研究  

Predictive value of diaphragmatic rapid shallow breathing index in weaning from mechanical ventilation in patients with abdominal sepsis

作　　者：赵永华[1] 靳立振 于巧青 孟伟[2] 刘东海[1] 晁怀宇[1] Zhao Yonghua;Jin Lizhen;Yu Qiaoqing;Meng Wei;Liu Donghai;Chao Huaiyu(Department of Critical Care Medicine,Langfang People′s Hospital,Langfang 065000,China;Department of Radiological Diagnosis,Langfang People′s Hospital,Langfang 065000,China)

机构地区：[1]廊坊市人民医院重症医学科,065000 [2]廊坊市人民医院放射诊断科,065000

出　　处：《国际呼吸杂志》2020年第15期1148-1153,共6页International Journal of Respiration

基　　金：廊坊市科技支撑计划项目(2017013083)。

摘　　要：目的:评估膈肌浅快呼吸指数(D-RSBI)对于腹部脓毒症患者机械通气撤机成功的预测价值。方法:采用前瞻性观察研究,在自主呼吸试验结束时记录患者呼吸频率、潮气量,并应用M超声测量评估右侧膈肌移动度,记录机械通气时间、重症监护病房(ICU)住院时间和ICU死亡率及撤机是否成功。采用受试者工作特征(ROC)曲线分析浅快呼吸指数(RSBI)及D-RSBI对撤机失败预测的准确性。结果:本研究纳入58例患者,其中撤机成功组为40例(69.0%),撤机失败组为18例(31.0%)。撤机失败组的RSBI高于撤机成功组( Z=-4.45, P<0.01),撤机失败组的D-RSBI高于撤机成功组( Z=-5.50, P<0.01)。RSBI的ROC曲线下面积为0.84(95% CI:0.73~0.94),临界值为69次·min -1·L -1,敏感度为87%,特异度为65%;D-RSBI的ROC曲线下面积为0.95(95% CI:0.90~1.00),临界值为1.8次·min -1·L -1,敏感度为89%,特异度为90%。 结论:D-RSBI预测撤机失败比传统指标RSBI更准确。Objective To evaluate the predictive value of diaphragmatic rapid shallow breathing index(D-RSBI)in weaning outcome in patients with abdominal sepsis.Methods A prospective observational study was performed.Respiratory rate and tidal volume were recorded at the end of spontaneous breathing trial,and the right diaphragmatic displacement was determined by M-mode ultrasonography.Other indicators related to weaning were also recorded,including the length of mechanical ventilation,length of stay and mortality in intensive care unit.The receiver operator characteristic(ROC)curve was used to assess the value of rapid shallow breathing index(RSBI)and D-RSBI in predicting weaning from mechanical ventilation in patients with abdominal sepsis.Results A total of 58 patients were eligible for the analysis,among whom 40 patients(69.0%)were successfully weaned,and 18 patients(31.0%)were not.RSBI and D-RSBI in the unsuccessful weaning group were higher than those in the successful weaning group(Z=-4.45,-5.50,all P<0.01).The area under ROC curve of RSBI was 0.84(95%CI:0.73-0.94),the optimum cutoff value of RSBI was 69 breaths·min-1·L-1,the sensitivity was 87%,and the specificity was 65%.The area under ROC curve of D-RSBI was 0.95(95%CI:0.90-1.00),the optimum cutoff value of D-RSBI was 1.8 breaths·min-1·L-1,the sensitivity was 89%,and the specificity was 90%.Conclusions D-RSBI is more accurate than RSBI in predicting the weaning outcome of abdominal sepsis patients with mechanical ventilation.

关 键 词：腹部脓毒症 浅快呼吸指数 撤机 膈肌 

分 类 号：R459.7[医药卫生—急诊医学]