下腔静脉变异度联合股直肌萎缩分数预测有创机械通气撤机结局的可行性分析  

Feasibility analysis of inferior vena cava variability combined with rectus femoris atrophy fraction in predicting the outcome of weaning from invasive mechanical ventilation

作　　者：吴衡 朱超云 刘媛 蒋宝虎 Wu Heng;Zhu Chaoyun;Liu Yuan;Jiang Baohu(Department of Emergency Medicine,the Affiliated Yixing Hospital of Jiangsu University,Yixing 214200,China)

机构地区：[1]江苏大学附属宜兴医院急诊医学科,宜兴214200

出　　处：《中华急诊医学杂志》2023年第3期377-382,共6页Chinese Journal of Emergency Medicine

基　　金：无锡市卫生健康委科研面上项目(M202056)。

摘　　要：目的探讨下腔静脉变异度(inferior vena cava variability,ΔDIVC)联合股直肌萎缩分数预测有创机械通气(invasive mechanical ventilation,IMV)撤机结局的可行性分析。方法选取2021年1月至2021年12月江苏大学附属宜兴医院收治的IMV患者进行前瞻性研究。达到撤机标准的患者进行2 h自主呼吸试验(spontaneous breathing trial,SBT),然后立即拔管。将拔管超过48 h且自主呼吸稳定的患者纳入撤机成功组,反之纳入撤机失败组。评价两组临床资料和各项撤机指标。分析ΔDIVC和股直肌萎缩分数的相关性、对撤机结局产生影响的因素。ΔDIVC、股直肌萎缩分数和两项联合预测撤机成功的诊断价值通过受试者工作曲线(ROC)进行分析。结果本研究共纳入60例IMV患者,其中38例撤机成功,22例撤机失败。两组临床资料特征差异无统计学意义(均P>0.05)。两组股直肌横截面积随重症监护病房(ICU)住院时间延长逐渐缩小(F值分别为3.266、3.625,均P<0.05),首次SBT时股直肌横截面积明显低于入院第1天[撤机成功组:(2.54±0.88)cm2 vs.(3.08±0.98)cm2;撤机失败组:(2.22±0.87)cm2 vs.(3.02±1.10)cm2,均P<0.05],但组间比较差异均无统计学意义(均P>0.05)。撤机成功组患者ΔDIVC和股直肌萎缩分数显著高于撤机失败组[ΔDIVC:(25.02±4.65)%vs.(20.30±3.16)%;股直肌萎缩分数:(81.89±5.09)%vs.(72.68±8.98)%,均P<0.05]。ΔDIVC和股直肌萎缩分数呈正相关(r=0.346,P=0.007)。ΔDIVC和股直肌萎缩分数均是影响撤机成功的重要因素(均P<0.05)。ΔDIVC联合股直肌萎缩分数预测撤机成功的曲线下面积(area under the curve,AUC)为0.880,显著高于ΔDIVC(AUC=0.791)和股直肌萎缩分数(AUC=0.826)。结论ΔDIVC联合股直肌萎缩分数预测IMV撤机成功具有较高的准确性,可用于指导撤机。Objective To identify the feasibility of inferior vena cava variability(ΔDIVC)combined with rectus femoris atrophy fraction in predicting the outcome of weaning from invasive mechanical ventilation(IMV).Methods From January to December 2021,the patients with the need for IMV admitted to the Affiliated Yixing Hospital of Jiangsu University were recruited into prospective case-control study.The patients who met the withdrawal criteria were treated with a 2-h spontaneous breathing trial(SBT)and then extubated immediately.Patients with stable spontaneous breathing after extubation for more than 48 h were classified as successful weaning group,and on the contrary,the other patients were classified as failed weaning group.The clinical data and withdrawal indexes of the two groups were evaluated.The correlation betweenΔDIVC and rectus femoris atrophy fraction was assessed.The influencing factors of weaning outcome were observed.The diagnostic value ofΔDIVC,rectus femoris atrophy fraction and the combination of two indexes in predicting weaning success were calculated by a plotting receiver operating characteristic(ROC)curve.Results Sixty IMV patients were included in this study,including 38 cases of successful weaning and 22 cases of failed weaning.The two groups were comparable with regard to clinical data(all P>0.05).The rectus femoris cross-sectional area in the two groups diminished gradually with the length of ICU stay(F=3.266,3.625,both P<0.05).The rectus femoris cross-sectional area at the first SBT was significantly lower than that on the first day of admission in both groups[the successful weaning group:(2.54±0.88)cm2 vs.(3.08±0.98)cm2;the failed weaning group:(2.22±0.87)cm2 vs.(3.02±1.10)cm2,both P<0.05],but there was no significant difference between the two groups(all P>0.05).Patients in the successful weaning group had higherΔDIVC and higher rectus femoris atrophy fraction than those in the weaning failure group[ΔDIVC:(25.02±4.65)%vs.(20.30±3.16)%;rectus femoris atrophy fraction:(81.89±5.09)%vs.

关 键 词：下腔静脉变异度 股直肌萎缩分数 肌肉萎缩 撤机指标 有创机械通气 超声检查 

分 类 号：R459.7[医药卫生—急诊医学]