床旁超声膈肌功能监测对机械通气患者撤机的指导价值  

The Clinical Value of Evaluation of Diaphragmatic Function by Ultrasound in Guiding the Weaning of Machinery Ventilates Patient

作　　者：黄晓丽 李颖川[2] 封凯旋[1] 苟鑫[1] Huang Xiaoli;Li Yingchuan;Feng Kaixuan;Gou Xin(Department of Centrality ICU,Jinshan Branch of Shanghai Sixth People's Hospital,Shanghai 201599,China;Department of Critical Care Medicine,theSixth People's Hospital Affiliated to Shanghai Jiaotong University,Shanghai 200240.China)

机构地区：[1]上海市第六人民医院金山分院中心ICU,上海市201599 [2]上海交通大学附属第六人民医院重症医学科,上海市200240

出　　处：《中国超声医学杂志》2022年第6期657-661,共5页Chinese Journal of Ultrasound in Medicine

摘　　要：目的探究床旁超声检测膈肌功能在预测重症监护机械通气患者撤机结果中的指导价值。方法纳入经机械通气治疗患者100例,随机分为两组(n=50)。对照组实施自主呼吸试验(SBT)的浅快呼吸指数(RSBI)撤机方案,观察组实施RSBI联合膈肌厚度变化率(DTF)撤机方案,对比不同撤机方案以及观察组不同撤机结果的临床指标差异,根据受试者工作特征(ROC)曲线拔管失败截断值(Cutoff)制定新的拔管条件。结果(1)相比对照组,观察组患者的机械通气时间、ICU住院时间、呼气末膈肌厚度低(P<0.05)。(2)相比对照组,观察组的撤机成功率高(χ^(2)=4.336,P=0.037)。(3)相比撤机失败者,撤机成功者DTF高,RSBI小(P<0.05)。(4)相比RSBI、DTF单独应用,RSBI联合DTF的AUC、灵敏度、约登指数均高(P<0.05)。结论DTF联合RSBI有助于提升撤机成功率并可以作为预测机械通气患者撤机结果指导方案。Objective To explore the guiding value of bedside ultrasound detection of diaphragm function in predicting the results of weaning in intensive care patients with mechanical ventilation.Methods A total of 100 patients who received mechanical ventilation were enrolled and randomly divided into two groups(n=50).The control group was given the spontaneous breathing test(SBT)with shallow rapid respiratory index(RSBI)withdrawal plan,and the observation group was given the RSBI combined with the rate of change of diaphragm thickness(DTF)withdrawal plan.The clinical indicators of different withdrawal plans and the observation group were compared.According to the Cutoff value of Cutoff of receiver operating characteristic(ROC)curve,a new Cutoff condition is formulated.Results(1)compared with the control group,the duration of mechanical ventilation,length of stay in ICU and diaphragm thickness at the end of expiratory were lower in the observation group(P<0.05).(2)Compared with the control group,the success rate of disconnecting was higher in the observation group(χ^(2)=4.336,P=0.037).(3)Compared with the losers,the successful ones had higher DTF and lower RSBI(P<0.05).(4)Compared with RSBI and DTF alone,THE AUC,sensitivity and Jorden index of RSBI combined with DTF were significantly higher(P<0.05).Conclusions DTF combined with RSBI is helpful to improve the success rate of discontinuation and can be used as a guidance program to predict the discontinuation results of mechanical ventilation patients.

关 键 词：撤机 膈肌增厚率 浅快呼吸指数 自主呼吸试验 重症医学科 

分 类 号：R445.1[医药卫生—影像医学与核医学]