整合超声评估在预测机械通气患者撤机结局中的应用  

Predictive Value of Multi-organ Ultrasonography on Ventilator Weaning Outcomes

作　　者：罗邦军 林转娣 梁结柱 林桂仪 蔡晶晶 LUO Bangjun;LIN Zhuandi;LIANG Jiezhu(Intensive Care Unit,Panyu Central Hospital,Guangzhou City,Guangdong Province 511400)

机构地区：[1]广东省广州市番禺区中心医院重症医学科,511400

出　　处：《医学理论与实践》2023年第11期1812-1814,1804,共4页The Journal of Medical Theory and Practice

基　　金：广州市番禺区科技计划项目(2020-Z04-096)。

摘　　要：目的:探讨整合超声评估在预测机械通气患者撤机结局中的应用价值。方法:选取2020年1月1日—2022年4月30日所有入住重症医学科的成人机械通气超过24h且临床判断将进入撤机程序的患者。对纳入人群均进行床旁整合超声评估,监测内容:心脏超声、肺部超声失气化评分、膈肌超声以及下腔静脉超声监测。根据整合超声监测信息、撤机结局、预后分析困难或延迟撤机的危险因素。结果:纳入机械通气患者59例,其中26例简单撤机,33例困难或延迟撤机。困难或延迟撤机组患者血磷水平、APACHEⅡ评分高于简单撤机组,差异具有统计学意义(P<0.05)。与简单撤机组比较,困难或延迟撤机组患者RSBI、肺部超声失气化评分、IVCmax显著升高,DM、DVC、TF显著降低,差异具有统计学意义(P<0.05)。多因素Logistic回归分析显示,肺部超声失气化评分、TF是困难或延迟撤机的独立危险因素(P=0.003、0.022;AUC=0.837、0.770)。结论:床旁整合重症超声可为撤机前高危因素筛查提供依据,能准确预测机械通气患者撤机结局,具有很高的临床实用价值。Objective:To assess predictive value of multi-organ ultrasonography on ventilator weaning outcomes.Methods:This study from January 1st 2020 to April 30th 2022 done on 59 adult mechanically ventilated patients>24 hours who underwent the weaning process.The risk factors of difficult or prolonged weaning were analyzed according to the results of multi-organ ultrasonography,weaning outcome and prognosis.Results:59 patients included in mechanical ventialtion 26 patients had simple weaning and 33 patients had either difficult or prolonged weaning.The blood phosphorus level and APACHEⅡscore of difficult or prolonged weaning group were higher than those of simple weaning group(P<0.05).Compared with simple weaning group,RSBI,Lung ultrasound score and IVCmax were significantly higher in difficult or prolonged weaning group,while DM,DVC and TF were significantly lower(P<0.05).Logistic analysis showed that Lung ultrasound score and Thickening fraction were independent risk factors of difficult or prolonged weaning(P=0.003,0.022;AUC=0.837,0.770).Conclusion:Multi-organ ultrasonography can effectively predict ventilator weaning outcomes.

关 键 词：整合超声 机械通气 撤机 

分 类 号：R445.1[医药卫生—影像医学与核医学] R459.7[医药卫生—诊断学]