床旁肺超声评估对机械通气患者撤机结局的预测价值  

Predictive value of bedside lung ultrasound evaluation in the weaning outcome of the patients with mechanical ventilation

作　　者：兰频 潘群婕[2] 方伟钧[2] 吴春双 徐杰丰[1] 张茂[1] Lan Pin;Pan Qun-jie;Fang Wei-jun;Wu Chun-shuang;Xu Jie-fertg;Zhang Mao(Department of Emergency Medicine,the Second.Affiliated Hospital of Medical School of Zhejiang University;Institute of Emergency Medicine,Zhejiang University,Hangzhou 310009,China)

机构地区：[1]浙江大学医学院附属第二医院急诊医学科浙江大学急救医学研究所,浙江杭州310009 [2]丽水市中心医院急诊医学科,浙江丽水323000

出　　处：《中国急救医学》2020年第11期1059-1064,共6页Chinese Journal of Critical Care Medicine

摘　　要：目的探讨床旁肺超声评分(LUS)对机械通气患者撤机结局的预测价值.方法采用前瞻性研究方法,选择2017年12月至2018年4月浙江大学医学院附属第二医院急诊ICU收治的45例进行机械通气的危重患者,记录患者年龄、性别、急性生理和慢性健康状况评估系统Ⅱ(APACHEⅡ)评分、机械通气时间等临床资料.所有患者在自主呼吸试验(SBT)0 min、30 min和撤机后1h、6h、24 h、48 h时进行LUS、膈肌活动度(DE)、氧合指数(OI)等检测.根据机械通气撤机结局,将患者分为撤机成功组(n=33)和撤机失败组(n=12),比较两组患者的LUS、DE及OI等指标的变化.采用受试者工作特征(ROC)曲线评估LUS、DE及OI对危重患者机械通气撤机结局的预测价值.采用Pearson相关性分析评估LUS与DE、OI之间的相关性.结果45例患者均纳入分析,其中撤机成功33例、撤机失败12例.撤机成功组与失败组患者年龄、性别、APACHEⅡ评分及机械通气时间等一般临床资料,比较差异均无统计学意义(P>0.05).与撤机失败组相比,撤机成功组在SBT 0 min、30 min及撤机后1h、6h、24 h、48 h时间点的LUS明显减少,DE和OI明显增大,组间比较差异均有统计学意义[LUS(分):SBT 0 min为9.3±4.2 vs.14.9±3.5,30 min为9.5±4.0 vs.16.2±3.5,撤机后1h为10.4±4.4 vs.17.8±3.4,6h为10.1±5.2 vs.21.2±3.2,24 h为8.7±5.6 vs.22.0±3.9,48 h为8.3±4.9 vs.21.3±2.7;DE(cm):SBT0 min为1.49±0.42 vs.0.82±0.18,30 min为1.51±0.44 vs.0.80±0.17,撤机后1h为1.45±0.48vs.0.71±0.19,6 h为1.45±0.51 vs.0.73±0.28,24 h为1.48±0.69 vs.0.85±0.28,48 h为1.50±0.73 vs.0.84±0.24;OI(mm Hg):SBT 0 min为302.0±78.3 vs.250.9±16.6,30 min为302.6±100.1 vs.229.3±62.4,撤机后1h为288.9±102.5 vs.163.2±53.9,6h为275.9±81.0vs.165.4±40.1,24 h为289.3±110.2 vs.176.2±71.9,48 h为294.2±94.8 vs.174.7±44.8,均P<0.05].ROC分析显示,在SBT 0 min和30 min时,LUS预测撤机成功的曲线下面积(AUC)分别为0.833和0.886,以LUS≤10.5分和≤11.5分为Objective To investigate the predictive value of bedside lung ultrasound score(LUS) in the weaning outcome of the patients with mechanical ventilation.Methods A prospective study was conducted.Forty-five patients with critical illness undergoing mechanical ventilation admitted to emergency intensive care unit of the second Affiliated Hospital of Medical School of Zhejiang University from December 2017 to April 2018 were enrolled.The clinical data including the age,sex,acute physiology and chronic health evaluation Ⅱ(APACHE Ⅱ) score and mechanical ventilation duration were recorded.The values of LUS,diaphragm excursion(DE) and oxygenation index(01)were measured immediately(0 min) and at 30 min after spontaneous breathing trial(SBT),and at 1 h,6 h,24 h and 48 h after the weaning in all the patients.According to the weaning outcome of mechanical ventilation,the patients were divided into successful weaning group(n=33) and unsuccessful weaning group(n=12),and the changes of LUS,DE and OI were compared between the two groups.The predictive values of LUS,DE and OI in the outcome of weaning were evaluated by receiver operating characteristic curve(ROC).The relationship of LUS with DE and OI was evaluated by Pearson correlation analysis.Results Forty-five patients were all enrolled in this study,in which 33 patients were successfully weaned and 12 patients were unsuccessfully weaned.No differences in the age,sex,APACHE Ⅱ score and mechanical ventilation duration were observed between the successful weaning group and unsuccessful weaning group(P>0.05).The values of LUS were significantly lower,and the values of DE and OI were significantly higher in the successful weaning group at 0 min,30 min after SBT,and at 1 h,6 h,24 h and 48 h after the weaning compared with the unsuccessful weaning group[LUS(scores):9.3±4.2 vs.14.9±3.5 at 0 min after SBT,9.5±4.0 vs.16.2±3.5 at 30 min after SBT,10.4±4.4 vs.17.8±3.4 at 1 h after the weaning,10.1±5.2 vs.21.2±3.2 at 6 h after the weaning,8.7±5.6 vs.22.0±3.9 at 24 h after

关 键 词：危重症 机械通气 肺超声评分(LUS) 膈肌活动度(DE) 氧合指数(OI) 撤机 预测价值 

分 类 号：R459.7[医药卫生—急诊医学] R445.1[医药卫生—治疗学]