超声评估膈肌收缩能力和做功对撤机结局的预测价值  

Value of ultrasonic evaluation of diaphragm contractility and work done in predicting outcome of weaning

作　　者：董奕君 柏刚[2] 谭娅 张文君[2] DONG Yijun;BAI Gang;TAN Ya;ZHANG Wenjun(Taihe Hospital,Jinzhou Medical University Union Training Base,Shiyan,Hubei 442000,China;Department of Ultraosund,Taihe Hospital,Hubei University of Medicine,Shiyan,Hubei 442000,China)

机构地区：[1]锦州医科大学十堰市太和医院研究生培养基地,湖北十堰442000 [2]湖北医药学院附属十堰市太和医院超声医学科,湖北十堰442000

出　　处：《中国医学工程》2023年第5期25-29,共5页China Medical Engineering

摘　　要：目的探讨超声测量膈肌增厚率和位移-时间指数(E-T指数)对机械通气患者撤机结局的预测价值。方法本研究选取十堰市太和医院2021年7月至2022年7月重症医学科(ICU)内符合纳入标准的患者,对所有研究对象均行床旁超声检查,收集自主呼吸试验(SBT)进行30 min时的超声数据:①膈肌增厚率(DTF);②膈肌E-T指数。采用受试者工作特征(ROC)曲线确定膈肌超声指标预测撤机成功的最佳阈值。结果研究共纳入患者60例,其中撤机成功组42例,撤机失败组18例。成功组与失败组的一般临床资料,包括年龄、性别、体重指数(BMI)、急性生理和慢性健康评估Ⅱ评分(APACHEⅡ评分)以及是否行手术治疗等比较,差异均无统计学意义(P>0.05),而成功组的患者撤机前机械通气时间低于失败组(P<0.05)。在SBT进行30 min时,撤机成功组的DTF及E-T指数均高于失败组(P<0.05)。以DTF≥32.5%为最佳界值预测撤机成功,其敏感性71.4%,特异性83.3%,曲线下面积(AUC)0.824。以E-T指数≥0.99 cm⋅s为最佳界值预测撤机成功,为其敏感性76.2%,特异性77.8%,AUC 0.807。结论超声评估膈肌收缩能力和做功可较准确预测撤机结局。【Objective】To evaluate the value of diaphragm thickening rate and excursion-time(E-T)index measured by ultrasound in evaluating the outcome of weaning in patients with mechanical ventilation.【Methods】The patients who received mechanical ventilation in Intensive Care Unit(ICU)of Taihe Hospital of Shiyan City from July 2021 to July 2022 were included in the study.All subjects were examined by bedside ultrasound,and the ultrasonic data of autonomous breathing test(spontaneous breathing trial,SBT)for 30 minutes were collected:(1)diaphragm thickening fraction(DTF);(2)E-T index.The optimal threshold of diaphragm ultrasound index to predict the success of weaning was determined using receiver operating characteristic(ROC)curve.【Results】Success of weaning was found in 42 patients and 18 patients were in the failure group.There were no statistically significant differences in general clinical datum including age,sex,body mass index,acute physiology and chronic health conditionⅡscore and whether to undergo surgical treatment between the weaning success group and the weaning failure group(P>0.05),but the time of mechanical ventilation before weaning in the successful group was lower than that in the failed group(P<0.05).During 30 min in SBT,the DTF and E-T index of successful weaning group were significantly higher than those of failure group(P<0.05).A cutoff of DTF≥32.5%yielded a sensitivity of 71.4%,a specificity of 83.3%,and an area under the ROC curve(AUC)of 0.824.A cutoff of E-T index≥0.99 cm⋅s yielded a sensitivity of 76.2%,a specificity of 77.8%,and an area under the ROC curve(AUC)of 0.807.【Conclusion】The evaluation of diaphragm contractility and work done by ultrasound can accurately predict the outcome of weaning.

关 键 词：膈肌超声 重症 机械通气 撤机 自主呼吸试验 

分 类 号：R445.1[医药卫生—影像医学与核医学]