膈肌超声在心脏外科术后撤机中的价值  

The value of diaphragm ultrasound in the weaning of ventilator for patients undergoing cardiac surgery

作　　者：李雅琼 刘楠[1] 李呈龙[1] 王晓朦 李菁[2] 侯晓彤[1] LI Yaqiong;LIU Nan;LI Chenglong;WANG Xiaomeng;LI Jing;HOU Xiaotong(Department of Cardiovascular Centre of Intersive Care,Anzhen Hospital,Capital Medical University,Beijing Institute of Heart,Lung and Blood Vessel Diseases,Beijing 100029,China)

机构地区：[1]首都医科大学附属北京安贞医院-北京市心肺血管疾病研究所心脏外科危重症中心,100029 [2]首都医科大学附属北京安贞医院-北京市心肺血管疾病研究所心脏超声医学中心,100029

出　　处：《心肺血管病杂志》2024年第5期493-498,共6页Journal of Cardiovascular and Pulmonary Diseases

摘　　要：目的:超声评估膈肌功能在指导心脏外科术后有创机械通气患者撤机的临床预测价值。方法:选取2023年1月至2023年11月,在北京安贞医院接受心脏外科手术,同时进行了膈肌超声监测的患者,根据患者撤机后结果将其分为撤机成功组和撤机失败组。通过Logistic回归分析撤机失败的危险因素,床旁超声测定患者的膈肌增厚率(diaphragm thickening fraction,DTF)和膈肌移动度(diaphragmatic excursion,DE),应用受试者工作特征(receiver operating characteristic curve,ROC)曲线评估DTF和DE用于预测有创机械通气患者撤机结果的价值。结果:共纳入103例患者,住院死亡率为2.9%(n=3)。撤机失败组12例,撤机成功组91例,撤机失败组患者的肺部感染(41.7%vs.2.2%,P<0.001)、肝功能不全(25%vs.4.4%,P=0.008)及肾功能不全发生率(25%vs.1.1%,P=0.005)均显著高于撤机成功组。撤机失败组患者的手术时间、机械通气时间及ICU滞留时间更长(手术时间:7 h vs.4h,P=0.001;机械通气时间:47h vs.20h,P=0.019;ICU滞留时间:7d vs.2d,P=0.001)。膈肌功能障碍的发生率为45.6%(n=47)。Logistic回归分析显示膈肌活动度减低及膈肌增厚率减低均是撤机失败的危险因素。ROC曲线分析显示膈肌增厚率预测撤机失败的敏感度71.1%,特异度75%;膈肌移动度敏感度78.9%,特异度83.3%。结论:膈肌移动度及膈肌增厚率均对心脏外科术后撤机有较好预测价值。Objective:The clinical value of ultrasound assessment of diaphragm function in guiding the weaning of ventilator for patients undergoing cardiac surgery.Methods:A total of 103 patients who underwent cardiac surgery in the Department of Cardiac Surgery,Beijing Anzhen Hospital from January 2023 to November 2023 and underwent diaphragm ultrasound monitoring were selected and divided into weaning success group and weaning failure group according to the results of weaning.Logistic regression analysis was performed to analyze the risk factors of weaning failure,diaphragm thickening fraction(DTF)and diaphragmatic excursion(DE)were measured by ultrasound,and receiver operating characteristic curve(ROC)curve was used to evaluate DTF and DE for predicting ventilator weaning outcomes.Results:A total of 103 patients were included,with an in-hospital mortality rate of 2.9%(n=3).There were 12 cases in the weaning failure group and 91 cases in the weaning group,and the incidence of pulmonary infection(41.7%vs.2.2%,P<0.001),liver insufficiency(25%vs.4.4%,P=0.008)and renal insufficiency(25%vs.1.1%,P=0.005)in the weaning failure group were significantly higher than those in the weaning group.Compared with the weaning group,the operation time,mechanical ventilation time and ICU stay time were longer in the weaning failure group(operation time:7 h vs.4 h,P=0.001;mechanical ventilation time:47 h vs.20h,P=0.019;ICU stay time:7 days vs.2 days,P=0.001).The incidence of diaphragmatic dysfunction was 45.6%(n=47).Logistic regression analysis showed that decreased diaphragm mobility and diaphragm thickening rate were independent risk factors for weaning failure.ROC curve analysis showed that diaphragm thickening rate had a sensitivity of 71.1% and a specificity of 75% in predicting weaning failure.The sensitivity and specificity of diaphragm mobility were 78.9% and 83.3%.Conclusions:Both DE and DTF have good clinical predictive value for weaning in patients undergoing cardiac surgery.

关 键 词：膈肌功能 心脏外科术后 撤机 

分 类 号：R54[医药卫生—心血管疾病]