膈肌移动度预测重症肺炎患者有创机械通气需求及死亡风险的临床价值  

Clinical value of diaphragm excursion in predicting the need of invasive mechanical ventilation and the mortality risk in patients with severe pneumonia

作　　者：尹莉[1] 葛辉玉 王斯宇 李元子 郭树彬[2] 张谱 郭瑞君[1] YIN Li;GE Huiyu;WANG Siyu;LI Yuanzi;GUO Shubin;ZHANG Pu;GUO Ruijun(Department of Ultrasound Medicine,Beijing Chao-Yang Hospital,Capital Medical University,Beijing 100020,China)

机构地区：[1]首都医科大学附属北京朝阳医院超声医学科,北京市100020 [2]首都医科大学附属北京朝阳医院急诊医学科,北京市100020 [3]河北燕达医院超声医学科

出　　处：《临床超声医学杂志》2023年第10期775-779,共5页Journal of Clinical Ultrasound in Medicine

摘　　要：目的 探讨膈肌移动度(DE)预测重症肺炎患者有创机械通气(IMV)需求及死亡风险的临床价值。方法 收集我院急诊医学科收治的53例成年重症肺炎患者,入院12 h内均行膈肌超声检查获得DE,根据住院期间是否行IMV分为机械通气组(MV组)16例和无机械通气组(NMV组)37例;根据入院30 d内临床结局分为死亡组25例和存活组28例。比较MV组与NMV组、死亡组与存活组DE的差异;绘制受试者工作特征(ROC)曲线分析DE预测重症肺炎患者IMV需求及死亡风险的临床价值。结果 MV组DE低于NMV组[(1.15±0.60)cm vs.(1.67±0.79)cm];死亡组DE低于存活组[(1.07±0.59)cm vs.(1.91±0.70)cm],差异均有统计学意义(均P<0.05)。ROC曲线分析显示,DE预测重症肺炎患者IMV需求的截断值为1.28 cm,灵敏度为68.8%,特异度为67.7%,曲线下面积为0.694(95%可信区间:0.547~0.841);DE预测重症肺炎患者死亡风险的截断值为1.21 cm,灵敏度为68.0%,特异度为82.1%,曲线下面积为0.816(95%可信区间:0.702~0.931)。结论 DE对重症肺炎患者IMV需求和死亡风险均有一定的早期预测价值。Objective To explore the clinical value of diaphragm excursion(DE)in predicting the need of invasive mechanical ventilation(IMV)and the mortality risk in patients with severe pneumonia.Methods A total of 53 adult patients with severe pneumonia admitted to the emergency department of our hospital were collected.All patients received diaphragmatic ultrasound examination within 12 h after admission to obtained DE,and they were divided into mechanical ventilation group(MV group,n=16)and non-mechanical ventilation group(NMV group,n=37)according to whether IMV was performed during hospitalization.The patients were divided into death group(n=25)and survival group(n=28)according to the clinical outcomes of 30 d after admission.The differences of DE between MV group and NMV group,death group and survival group were compared.Receiver operating characteristic(ROC)curve was drawn to analyze the clinical value of DE in predicting the need of IMV and mortality risk in patients with severe pneumonia.Results The DE of the MV group was lower than that of the NMV group[(1.15±0.60)cm vs.(1.67±0.79)cm],the DE of the death group was lower than that of the survival group[(1.07±0.59)cm vs.(1.91±0.70)cm],and the differences were statistically significant(both P<0.05).ROC curve analysis showed that the cut-off value of the DE for predicting the need of IMV in patients with severe pneumonia was 1.28 cm,the sensitivity was 68.8%,the specificity was 67.7%,and the area under the curve(AUC)was 0.694(95%confidence interval:0.547~0.841).The cut-off value of the DE for predicting the mortality risk in patients with severe pneumonia was 1.21 cm,the sensitivity was 68.0%,the specificity was 82.1%,and the AUC was 0.816(95%confidence interval:0.702~0.931).Conclusion DE has a certain early value in predicting the need of IMV and the mortality risk in patients with severe pneumonia.

关 键 词：超声检查 膈肌移动度 重症肺炎 机械通气 预测价值 

分 类 号：R445.1[医药卫生—影像医学与核医学] R563.1[医药卫生—诊断学]