超声评价有创机械通气患者膈肌功能的研究初探  

A preliminary study on the evaluation of diaphragm function by ultrasound in patients with invasive mechanical ventilation

作　　者：孙杨[1] 张丽娜[1] 冯清 李莉[1] 艾美林 曹岚[1] 田盾 杨清[1] 无 Sun Yang;Zhang Lina;Feng Qing;Li Li;Ai Meilin;Cao Lan;Tian Dun;Yang Qing;无(Department of Critical Medicine,Xiangya Hospital,Central South University,National Clinical Research Center for Geriatric Disorders,Changsha 410008,China;Chinese Critical Ultrasound Study Group)

机构地区：[1]中南大学湘雅医院重症医学科,国家老年疾病临床医学研究中心,长沙410008 [2]中国重症超声研究组

出　　处：《中华内科杂志》2020年第9期695-699,共5页Chinese Journal of Internal Medicine

摘　　要：目的初步研究超声评价有创机械通气患者膈肌功能的可行性。方法选2017年3—12月入住中南大学湘雅医院重症医学科行有创机械通气超过48 h的40例成人急性呼吸窘迫综合征患者。连续5 d应用超声测量患者左、右两侧前、中、后部膈肌位移和膈肌厚度。结果(1)与第1天患者右侧[前部:(11.05±3.04)mm;中部:(12.08±2.71)mm;后部:(11.51±3.33)mm]和左侧[前部:(13.63±7.52)mm;中部:(15.44±7.52)mm;后部:(14.76±6.93)mm]膈肌位移比,第3天右侧[前部(8.90±3.65)mm;中部(10.02±4.24)mm;后部(10.25±4.38)mm]和左侧[前部(9.82±1.96)mm;中部(11.60±1.13)mm;后部(11.52±1.98)mm]膈肌位移发生明显下降,差异有统计学意义(P<0.05);左、右两侧前、中、后部膈肌位移均于第5天恢复,且高于第1天,其中左侧中部和后部膈肌位移变化最明显。(2)与第1、2、3天比,第4天左、右两侧前、中、后部膈肌增厚率明显下降,其中左侧中部[第1天:(33.87±14.34)%;第2天:(37.26±13.91)%;第3天:(30.56±14.27)%;第4天:(15.53±5.68)%]和后部[第1天:(35.50±15.69)%;第2天:(39.84±15.32)%;第3天:(29.06±14.96)%;第4天:(13.30±5.79)%]膈肌增厚率变化最明显,差异有统计学意义(P<0.05)。左侧前、中、后部膈肌增厚率第5天较第4天有所恢复,但仍低于第1天。结论超声评价有创机械通气患者膈肌功能是可行的,可为预防膈肌萎缩和撤离机械通气提供指导作用。Objectives To study the feasibility of using ultrasound to evaluate diaphragm function in patients with invasive mechanical ventilation.Methods From March to December 2017,40 adult patients with acute respiratory distress syndrome who were admitted to the Department of Critical Care Medicine,Xiangya Hospital,Central South University for more than 48 hours were included.Diaphragmatic excursion and thickness of bilateral anterior,middle and posterior parts were measured by ultrasound for 5 consecutive days.Results(1)Compared with the diaphragmatic excursion of the right[anterior:(11.05±3.04)mm;middle:(12.08±2.71)mm;posterior:(11.51±3.33)mm]and left[anterior:(13.63±7.52)mm;middle:(15.44±7.52)mm;posterior:(14.76±6.93)mm]sides on day 1,the diaphragmatic excursion of the right[anterior:(8.90±3.65)mm;middle:(10.02±4.24)mm;posterior:(10.25±4.38)mm]and left[anterior:(9.82±1.96)mm;middle:(11.60±1.13)mm;posterior:(11.52±1.98)mm]sides decreased significantly on day 3(P<0.05).Bilateral anterior,middle and posterior diaphragmatic excursion recovered on day 5,and was higher than the baseline levels on day 1,with the left middle and posterior diaphragmatic excursion changing most significantly.(2)Compared with day 1,2,3,the thickening fraction of bilateral anterior,middle and posterior diaphragm were significantly decreased on day 4,with the left middle part[day 1:(33.87±14.34)%;day 2:(37.26±13.91)%;day 3:(30.56±14.27)%;day 4:(15.53±5.68)%]and the left posterior part[day 1:(35.50±15.69)%;day 2:(39.84±15.32)%;day 3:(29.06±14.96)%;day 4:(13.30±5.79)%]changing most significantly(P<0.05).The thickening fractions of left anterior,middle and posterior diaphragm recovered on day 5 compared with that on day 4,but still lower than those on day 1(P<0.05).Conclusions It is feasible to evaluate the diaphragm function in patients with invasive mechanical ventilation by ultrasound,which can provide guidance for preventing diaphragmatic atrophy and withdrawing from mechanical ventilation.

关 键 词：膈肌功能 机械通气 超声 重症 

分 类 号：R563.8[医药卫生—呼吸系统] R445.1[医药卫生—内科学]