浅快呼吸指数相关指标预测脱机结局的价值分析  

Value of rapid shallow breathing index related indicators in predicting weaning outcomes

作　　者：周明素 马镇凡 贾晋太[2] 张栋[1] 刘燕 ZHOU Mingsu;MA Zhenfan;JIA Jintai;ZHANG Dong;LIU Yan(Department of Critical Care Medicine,Heping Hospital Affiliated to Changzhi Medical College,Changzhi,Shanxi,046000;Department of Anesthesiology,Heping Hospital Affiliated to Changzhi Medical College,Changzhi,Shanxi,046000)

机构地区：[1]长治医学院附属和平医院重症医学科,山西长治046000 [2]长治医学院附属和平医院麻醉科,山西长治046000

出　　处：《实用临床医药杂志》2021年第7期15-20,共6页Journal of Clinical Medicine in Practice

基　　金：山西省自然科学基金面上项目(201901D111332)。

摘　　要：目的比较浅快呼吸指数(RSBI)、膈肌浅快呼吸指数(D-RSBI)和膈肌增厚浅快呼吸指数(DT-RSBI)对脱机结局的预测价值。方法选择行机械通气治疗≥48 h且准备脱机的患者作为研究对象,在自主呼吸实验(SBT)结束或失败时测量膈肌增厚率(DTF)、膈肌位移(DE),同时记录呼吸频率和潮气量,用DE、DTF分别替代RSBI计算公式中的潮气量得到D-RSBI和DT-RSBI。达到脱机标准者进行脱机,根据脱机结果的不同将患者分为脱机成功组19例和脱机失败组13例。比较2组各指标差异,采用受试者工作特征(ROC)曲线评估各指标对脱机结局的预测价值。结果2组DE、DTF、RSBI、D-RSBI、DT-RSBI比较,差异有统计学意义(P<0.05)。DE、DTF能预测脱机成功(P<0.05),DTF和DE的阈值分别为20.50%和0.91 cm。D-RSBI、DT-RSBI和RSBI能预测脱机失败(P<0.05),分别以14.44次/(min·cm)、119.46次/min和66.83次/(min·L)为阈值,三者曲线下面积(AUC)分别为0.830、0.810和0.773。结论D-RSBI和DT-RSBI预测脱机结局较RSBI更准确,其中D-RSBI的准确性最高,可以替代RSBI指导脱机。Objective To compare the predictive value of rapid shallow breathing index(RSBI),diaphragm rapid shallow breathing index(D-RSBI)and diaphragm thickening rapid shallow breathing index(DT-RSBI)for weaning outcomes.Methods Patients with mechanical ventilation duration of 48 hours and above who were ready to be weaned were selected.At the end or failure of spontaneous breathing test(SBT),diaphragmatic thickening rate(DTF)and diaphragmatic excursion(DE)were measured,respiratory rate and tidal volume were recorded simultaneously,D-RSBI and DT-RSBI were obtained by replacing the tidal volume of RSBI with DE and DTF in the computational formula,respectively.The patients who reached the weaning standard were weaned and were divided into successful group(n=19)and failed group(n=13)according to weaning results.The difference of each index between the two groups was compared.The Receiver Operator Characteristic(ROC)curve was used to evaluate the value of each index in predicting weaning outcomes.Results DE,DTF,RSBI,D-RSBI and DT-RSBI showed significant differences between two groups(P<0.05).DE and DTF could predict success of weaning(P<0.05).The threshold values of DTF and DE in predicting weaning success were 20.50%and 0.91 cm,respectively.DT-RSBI,D-RSBI and RSBI could predict weaning failure(P<0.05).Taking 14.44 breaths/(min·cm),119.46 breaths/min and 66.83 breaths(min·L)as the threshold values,the areas under the curve(AUC)were 0.830,0.810 and 0.773,respectively.Conclusion D-RSBI and DT-RSBI are more accurate in predicting weaning outcomes than RSBI,and D-RSBI has the highest accuracy,which could guide weaning in stead of RSBI.

关 键 词：膈肌 脱机 浅快呼吸指数 膈肌浅快呼吸指数 膈肌增厚浅快呼吸指数 

分 类 号：R443.6[医药卫生—诊断学] R565.3[医药卫生—临床医学]