膈肌超声在有机磷中毒中间综合征机械通气患者撤机中的应用研究  

Application of diaphragm ultrasound in weaning of mechanical ventilation patients with intermediate syndrome of organophosphorous poisoning

作　　者：刘景刚[1] 陈爽 张哲 张珂[1] 包东 Liu Jinggang;Chen Shuang;Zhang Zhe;Zhang Ke;Bao Dong(Intensive Care Unit,Affiliated Huxi Hospital of Jining Medical University,Shanxian Central Hospital,Heze 274300,China;Department of Ultrasound,Affiliated Huxi Hospital of Jining Medical University,Shanxian Central Hospital,Heze 274300,China)

机构地区：[1]济宁医学院附属湖西医院单县中心医院重症医学科,山东274300 [2]济宁医学院附属湖西医院单县中心医院超声科,山东274300

出　　处：《国际医药卫生导报》2021年第4期497-500,共4页International Medicine and Health Guidance News

基　　金：济宁医学院教师科研扶持基金(JYFC2018FKJ062)。

摘　　要：目的探讨膈肌超声在有机磷中毒中间综合征(IMS)机械通气患者撤机中的应用价值。方法选择2017年5月至2020年5月本院重症医学科收治的IMS符合撤机筛查条件患者为研究对象,撤机筛查30 min床旁超声测量右侧膈肌平静呼气末厚度、最大吸气末厚度、平静呼吸移动度,计算平静呼吸膈肌收缩速度。根据撤机是否成功分为撤机成功组和撤机失败组。比较两组患者抬头力量、双上肢在近端肌力、平静呼气末膈肌厚度、最大吸气末膈肌厚度、平静呼吸膈肌移动度和平静呼吸膈肌收缩速度的差异。logistic回归分析影响撤机结果的危险因素。结果两组患者平静呼气末膈肌厚度、最大吸气末膈肌厚度、抬头力量和双上肢近端肌力比较差异均无统计学意义(均P>0.05)。撤机成功组患者平静呼吸膈肌移动度高于撤机失败组[(1.46±0.29)cm比(1.27±0.24)cm,P=0.001],平静呼吸膈肌收缩速度和APACHEⅡ评分低于撤机失败组[(1.57±0.27)cm/s比(1.76±0.34)cm/s,P=0.003;(20.6±2.9)比(22.1±3.0),P=0.021]。多因素logistic回归分析显示,平静呼吸膈肌移动度和平静呼吸膈肌收缩速度是影响IMS机械通气患者撤机结果的危险因素。结论膈肌超声可评估IMS患者膈肌功能并指导撤机,平静呼吸膈肌移动度和平静呼吸膈肌收缩速度是影响撤机结果的危险因素。Objective To investigate the application value of diaphragm ultrasound in weaning of mechanical ventilation patients with intermediate syndrome(IMS)of organophosphorous poisoning.Methods IMS patients who met the condition of weaning admitted to Intensive Care Unit of our hospital from May 2017 to May 2020 were enrolled.Within 30 minutes before weaning,bedside ultrasound was used to measure the patients'calm end-expiratory thickness of right diaphragm,maximum end-inspiratory thickness,and calm breathing displacement,and the diaphragm contraction velocity of calm breathing was calculated.The patients were divided into two groups according to the success or failure of weaning from mechanical ventilation.The differences between the two groups were compared in lifting strength,proximal muscle strength of upper limbs,diaphragmatic thickness at the end of calm expiration,diaphragmatic thickness at the end of maximum inspiration,diaphragmatic displacement and contractile velocity of calm breathing.The related factors affecting the weaning results were analyzed by logistic regression analysis.Results There were no statistically significant differences in diaphragm thickness at the end of calm expiration,diaphragmatic thickness at the end of maximum inspiration,lifting strength,or proximal muscle strength of upper limbs between the two groups(all P>0.05).The diaphragmatic displacement of calm breathing in the success group was higher than that in the failure group[(1.46±0.29)cm vs.(1.27±0.24)cm,P=0.001],the diaphragmatic contractile velocity of calm breathing and APACHEⅡscore were lower than those in the failure group[(1.57±0.27)cm/s vs.(1.76±0.34)cm/s,P=0.003;(20.6±2.9)vs.(22.1±3.0),P=0.021].The multivariate logistic regression analysis showed that diaphragmatic displacement and contractile velocity of calm breathing were risk factors affecting weaning results from mechanical ventilation.Conclusions Diaphragmatic ultrasound can evaluate the function of diaphragm and guide the weaning from mechanical ventilation of

关 键 词：膈肌 超声 有机磷中毒 机械通气 撤机 

分 类 号：R595.4[医药卫生—内科学]