肺联合膈肌超声在预测有创机械通气撤离中的价值  

Predictive value of lung ultrasound combined with diaphragm ultrasound in weaning outcome from invasive mechanical ventilation

作　　者：曾娟利 蒋润梅 谢燕芝 Zeng Juanli;Jiang Runmei;Xie Yanzhi(Department of Respiratory and Critical Care Medicine,Hunan Provincial People's Hospital,the First Affiliated Hospital of Hunan Normal University,Changsha 410000,China;Department of Geriatrics,Changsha County People's Hospital,Xingsha District of Hunan Provincial People's Hospital,Changsha 410199,China)

机构地区：[1]湖南省人民医院,湖南师范大学附属第一医院呼吸与危重症医学科,长沙410000 [2]长沙县人民医院,湖南省人民医院星沙院区老年科,长沙410199

出　　处：《国际呼吸杂志》2022年第21期1641-1646,共6页International Journal of Respiration

摘　　要：目的探讨肺联合膈肌超声对有创机械通气患者撤机结局的预测价值。方法本研究为病例对照研究。采用非随机抽样的方法, 选取2020年1月至2021年12月湖南省人民医院86例有创机械通气患者, 撤机拔管前行自主呼吸实验(SBT), SBT通过后使用床旁超声进行肺和膈肌功能评估, 记录患者的肺部超声评分(LUS), 膈肌功能如呼气末膈肌厚度(DTee)、膈肌增厚分数(DTF)。撤机拔管后分撤机成功组(71例)和撤机失败组(15例), 通过比较2组的LUS、DTee、DTF的差异, 寻找预测撤机相关危险因素。运用受试者工作特征曲线比较各危险因素在SBT后的曲线下面积(AUC)以及敏感度和特异度, 并建立多指标组合模型以提高预测准确性。结果撤机成功组SBT后LUS低于撤机失败组, 而DTee、DTF高于撤机失败组, 差异均有统计学意义(P值均<0.05)。SBT后LUS增加(OR=0.636, P=0.005)、DTee变薄(OR=1.881, P=0.037)、DTF下降(OR=1.558, P=0.017)为撤机失败的独立危险因素。LUS、DTee和DTF预测机械通气患者撤机成功的AUC值分别为0.823、0.847、0.897, 三者结合的AUC=0.963。结论机械通气患者SBT后LUS增加、DTee变薄、DTF下降是撤机失败的独立危险因素;与单一的LUS、DTee、DTF评估方法相比, 三者联合对预测撤机是否成功有更好的准确性。Objective To explore the predictive value of lung ultrasound combined with diaphragmatic ultrasound for weaning outcome of invasive mechanical ventilation.Methods This study is a case-control study.A non-random sampling method was applicated to select 86 patients underwent invasive mechanical ventilation in Hunan Provincial People's Hospital from January 2020 to December 2021.After spontaneous breathing test(SBT),the bedside ultrasound was applied to evaluate lung and diaphragm functions.Lung ultrasound scores(LUS),diaphragm functions including diaphragm thickness(DTee)and diaphragm thickening fraction(DTF)were recorded.The patients were assigned to successful weaning group(n=71)and failed weaning group(n=15)after weaning and extubation.The differences of LUS,DTee and DTF between two groups were compared,and the risk factors related to predicting weaning were assessed.The receiver operating characteristic(ROC)curve was used to compare the area under the curve(AUC),the sensitivity and specificity of risk factors,and a multi-index combination model was established to improve the prediction accuracy.Results After SBT,LUS in successful weaning group was lower than that of failed weaning group,while DTee and DTF in successful weaning group were significantly higher than those of failed weaning group(all P<0.05).Elevated LUS(OR=0.636,P=0.005),thinner DTee(OR=1.881,P=0.037)and lowered DTF(OR=1.558,P=0.017)were independent risk factors for failed weaning.The AUC value of LUS,DTee and DTF of patients in successful weaning group were 0.823,0.847 and 0.897,respectively,and the AUC of the combination of LUS,DTee and DTF was 0.963.Conclusions Elevated LUS,thinned DTee and lowered DTF are independent risk factors for failed weaning.The threes combination have better predictive validity of the success weaning as compared to the single evaluation method of LUS,DTee and DTF.

关 键 词：呼吸 人工 肺部超声评分 呼气末膈肌厚度 膈肌增厚分数 撤机 

分 类 号：R459.7[医药卫生—急诊医学]