床旁肺部超声评分对机械通气患儿撤机结局的预测价值  

Predictive value of bedside lung ultrasound score on the outcome of liberation from mechanical ventilation in critically ill children

作　　者：张雯澜 傅丽娟[2] 王莹[2] 任宏[2] 陆红[2] 沈南平[2] 陆华 孙霁雯 ZHANG Wenlan;FU Lijuan;WANG Ying;REN Hong;LU Hong;SHEN Nanping;LU Hua;SUN Jiwen(Shanghai Jiao Tong University School of Nursing,Shanghai 200025,China;Shanghai Children's Medical Center,Shanghai Jiao Tong University School of Medicine,Shanghai 200127,China)

机构地区：[1]上海交通大学护理学院,上海200025 [2]上海交通大学医学院附属上海儿童医学中心,上海200127

出　　处：《临床儿科杂志》2020年第12期900-904,共5页Journal of Clinical Pediatrics

基　　金：上海市教委上海交通大学高原学科建设——科研骨干课题(No.Hlgy1823kygg);上海市教委上海交通大学建设——多学科创新基金(No.Hlgy1806dxk)。

摘　　要：目的探讨应用床旁肺部超声评分(LUS)对重症患儿撤机结局的预测价值。方法选取2019年1—12月收入重症监护病房的机械通气患儿。在撤机前对患儿实施床旁LUS,同步采集患儿的浅快呼吸指数(RSBI)和氧合指数(P/F值),随访撤机结局。用受试者工作特征曲线(ROC)及曲线下面积(AUC)评价LUS评分对患儿撤机结局的预测价值。结果共纳入患儿106例,男62例、女44例,中位年龄9(3,36)月。撤机成功97例(91.5%),失败9例(8.5%)。与撤机成功组相比,撤机失败组患儿的PICU住院时间、置管时间均延长,危重度评分降低,LUS和RSBI值较高,P/F值较低,差异均有统计学意义(P<0.05)。LUS评分≥16分是预测撤机失败发生的最佳界值(AUC为0.991、灵敏度88.9%、特异度97.9%,P<0.01),且预测效能显著优于P/F值和RSBI值(P<0.05)。结论床旁LUS能有效辅助评估重症患儿的撤机准备度,对患儿的撤机结局有较高的预测价值。Objective To explore the predictive value of bedside lung ultrasound score on the outcome of liberation from mechanical ventilation in critically ill children.Methods The children who received mechanical ventilation in the intensive care unit(ICU)from January to December 2019 were studied.The bedside lung ultrasound score(LUS)was performed before extubation,and the rapid shallow breathing index(RSBI)and oxygenation index(P/F)were collected simultaneously.The outcome of liberation was followed up.The receiver operating characteristic curve(ROC)and area under curve(AUC)were used to evaluate the predictive value of LUS score for the outcomes.Results In 106 children(62 boys and 44 girls)with median age of 9(3~36)months,97 cases(91.5%)were successful and 9 cases(8.5%)failed.Compared with the successful group,the PICU stay and catheterization time were longer,the severity score was lower,the LUS and RSBI were higher and the oxygenation index(P/F)was lower(all P<0.05)in the failure group.LUS score≥16 was the best cut-off value for predicting liberation failure(AUC=0.991,sensitivity 88.9%,specificity 97.9%,P<0.01),and the predictive efficacy was significantly better than P/F value and RSBI value(P<0.05).Conclusions Bedside LUS can effectively assist in evaluating the readiness of liberation from mechanical ventilation,and has a high predictive value for liberation outcome.

关 键 词：肺部超声评分 撤机 危重症患儿 预测分析 

分 类 号：R445.1[医药卫生—影像医学与核医学] R720.597[医药卫生—诊断学]