膈肌移动度联合膈肌浅快呼吸指数在机械通气患者撤机中的应用  

Application of diaphragm mobility combined with diaphragmatic superficial fast breathing index in weaning patients with mechanical ventilation

作　　者：郑华[1] 王真珍 李璐[1] ZHENG Hua;WANG Zhen-zhen;LI Lu(Department of Critical Care Medicine,the 7th People's Hospital of Zhengzhou,Zhengzhou 450000,China)

机构地区：[1]郑州市第七人民医院重症医学科,郑州450000

出　　处：《医药论坛杂志》2023年第13期11-15,共5页Journal of Medical Forum

基　　金：河南省医学科技攻关计划联合共建项目(LHGJ20220846)。

摘　　要：目的探讨膈肌移动度(diaphragm mobility,DD)联合膈肌浅快呼吸指数(diaphragmatic superficial fast breathing index,D-RSBI)在机械通气患者撤机中的应用价值。方法采用前瞻性观察研究,选择2021年4月—2022年4月郑州市第七人民医院综合ICU科接受机械通气>48 h的患者,在患者进行自主呼吸试验(SBT)30 min时,使用超声测量DD,评估患者膈肌功能;记录患者呼吸频率(RR)、潮气量(VT)以及其他生理参数,根据受试者工作特征曲线(ROC曲线),评价DD与D-RSBI以及两者联合在机械通气撤机中的预测价值。结果共纳入机械通气患者60例,其中撤机成功为41例(68.33%),撤机失败为19例(31.67%)。比较两组患者一般临床资料以及VT,差异无统计学意义(P>0.05);撤机成功组RR、RSBI、D-RSBI、ICU住院时间、机械通气时间均低于撤机失败组(P<0.05),撤机成功组的DD高于撤机失败组(P<0.05);多因素logistic回归分析结果显示,DD、D-RSBI均是影响撤机成功的独立因素(OR>1,P<0.05);绘制ROC曲线,结果显示,DD、D-RSBI预测机械通气患者撤机成功的AUC均>0.7,具有一定的预测价值,且两者联合AUC高于两者单独预测。结论DD联合D-RSBI可以有效预测机械通气撤机情况,进一步改善患者撤机结局。Objective To investigate the value of diaphragm mobility(DD)combined with diaphragmatic superficial fast breathing index(D-RSBI)in mechanical ventilation patients.Methods A prospective observational study was conducted to select the patients who received mechanical ventilation>48h in our hospital from April 2021 to April 2022.When the patients were undergoing spontaneous breathing test(SBT)for 30min,DD was measured by ultrasound to evaluate the diaphragm function of the patients.The respiratory rate(RR),tidal volume(VT)and other physiological parameters of the patients were recorded,and the predictive value of DD,D-RSBI and their combination in mechanical ventilation weaning was evaluated according to the subject's work characteristic curve(ROC curve).Results A total of 60 patients with mechanical ventilation were enrolled,of which 41 patients(68.33%)had successful weaning and 19 patients(31.67%)had failed weaning.There was no statistical significant difference in general clinical data and VT between the two groups(P>0.05).The RR,RSBI,D-RSBI,ICU hospitalization time and mechanical ventilation time in the successful weaning group were lower than those of the failed weaning group(P<0.05),and the DD in the successful weaning group was higher than that of the failed weaning group(P<0.05).Multivariate logistic regression analysis showed that DD and D-RSBI were independent factors influencing weaning success(OR>1,P<0.05).The ROC curve was drawn.The results showed that the AUC predicted by DD and D-RSBI for successful weaning of mechanical ventilation patients was greater than O.7,which had certain predictive value,and the AUC predicted by DD and D-RSBI combined was higher than that predicted by both alone.Conclusion DD combined with D-RSBI can effectively predict the weaning status of mechanical ventilation and further improve the weaning outcome of patients.

关 键 词：机械通气 浅快呼吸指数 膈肌移动度 膈肌浅快呼吸指数 撤机结局 

分 类 号：R459.7[医药卫生—急诊医学]