膈肌超声检查在指导肥胖患者撤离呼吸机的预测价值研究  

The Predictive Value of Diaphragmatic Ultrasound for Weaning from Mechanical Ventilation in Obese Patients

作　　者：赵永华[1] 靳立振 于巧青 孟伟[1] 刘东海[1] 晁怀宇[1] ZHAO Yonghua;JIN Lizhen;YU Qiaoqing(Langfang People's Hospital, Hebei Langfang 065000, China)

机构地区：[1]河北省廊坊市人民医院,河北廊坊065000

出　　处：《河北医学》2021年第8期1363-1367,共5页Hebei Medicine

基　　金：河北省廊坊市科技支撑计划项目,(编号:2017013083);河北省卫生健康委科研基金项目,(编号:20201303)。

摘　　要：目的:通过应用膈肌位移时间指数是否可以预测肥胖患者机械通气撤机成功。方法:采用前瞻性观察研究,在自主呼吸试验结束时记录患者呼吸频率、潮气量,并应用M超声测量评估右侧膈肌移动度,记录机械通气时间、ICU住院时间及撤机结局。采用受试者工作特征(ROC)曲线分析SBT时的E-T指数和A/C模式与SBT时E-T指数差值对撤机结局预测的准确性。结果:在SBT时,撤机成功组得DE、Ti、E-T指数明显高于撤机失败组(P<0.05),机械通气时间撤机成功组明显低于撤机失败组(P<0.05)。A/C模式与SBT时各参数的变化值ΔDE、ΔTi、ΔE-T指标,撤机成功与撤机失败比较有统计学意义(P<0.05)。SBT时的E-T指数的ROC曲线下面积为0.78(95%CI:0.59~0.96),阈值为1.02(cm·s),敏感度为75%,特异度为85%。A/C模式与SBT时E-T指数差值AUC为0.82(95%CI:0.68~0.92),阈值为-0.20(cm·s),敏感度为87.5%,特异度为75%。结论:SBT时膈肌E-T指数有助于预测撤机结局,增加A/C与SBT之间的膈肌E-T指数差值可增加成功撤机的可能。Objective:To evaluate the performance of diaphragmatic excursion-time index to predict the outcome of extubation.Methods:This was a prospective observation study.Respiratory rate and tidal volume were recorded at the end of spontaneous breathing trial(SBT).Both M-Mode and B-Mode ultrasonography were used to assess the right diaphragmatic displacement.Meanwhile,duration of mechanical ventilation,length of stay in ICU and outcome of the weaning were recorded.The receiver operator characteristic curves were used to evaluate the diagnostic accuracy of diaphragmatic E-T index measured during a spontaneous breathing trial and changes between A/C and SBT in diaphragm excursion,TI,and diaphragmatic E-T index.Results:During SBT,DE,Ti,E-T index in the successful weaning group were higher than those in the weaning group(P<0.05),duration of mechanical ventilation was shorter than those in the failure weaning group(P<0.05).ΔDE,ΔTi andΔE-T index in the successful weaning group was statistically different from the failure weaning group(p<0.05).The area under the ROC curve of E-T index measured during a spontaneous breathing trial was 0.78(95%CI:0.59-0.96),the optimal thresholds were 1.02(cm·s)with a sensitivity of 75%and a specificity of 85%.The area under the ROC curve of E-T index during transition from A/C to SBT was 0.82(95%CI:0.68~0.92),the optimal thresholds were-0.20(cm·s)with a sensitivity of 87.5%and a specificity of 75%.Conclusion:Diaphragm E-T index measured during SBT may help predict the outcome of extubation increase in diaphragm E-T index between A/C and SBT increases the likelihood of successful extubation.

关 键 词：膈肌位移时间指数 膈肌位移 撤机 

分 类 号：R56[医药卫生—呼吸系统]