膈肌浅快呼吸指数联合最大吸气压力对机械通气患者撤机结局的预测价值  

Predictive value of diaphragm rapid shallow breathing index combined with maximum inspiratory pressure in withdrawl of mechanical ventilation

作　　者：钟林 姜建平 盛菊萍 ZHONG Lin;JIANG Jianping;SHENG Juping(Intensive Care Unit,Pinghu First People's Hospital(Pinghu Hospital Affiliated to Hangzhou Medical College),Pinghu 314200,China)

机构地区：[1]平湖市第一人民医院(杭州医学院附属平湖医院)重症医学科,314200

出　　处：《浙江医学》2024年第12期1275-1279,共5页Zhejiang Medical Journal

基　　金：浙江省医药卫生科技计划项目(2023XY180);杭州医学院科技创新引导基金项目(CX2022020)。

摘　　要：目的探讨膈肌浅快呼吸指数(D-RSBI)联合最大吸气压力(MIP)在机械通气患者撤机结局中的预测价值。方法回顾性选取2022年9月至2023年9月平湖市第一人民医院重症医学科收治的通过自主呼吸试验(SBT)计划撤机的气管插管机械通气患者68例为研究对象。所有患者在SBT 30 min后撤机前测量膈肌移动度和MIP,同时记录呼吸频率,计算D-RSBI。根据撤机结局分为撤机成功组和撤机失败组。采用ROC曲线评估D-RSBI、MIP单独和两者联合对撤机结局的预测效能。结果68例患者中,撤机失败18例(26.47%),撤机成功50例(72.53%)。撤机失败组患者呼吸频率、D-RSBI均高于撤机成功组,膈肌移动度、MIP均低于撤机成功组,差异均有统计学意义(均P<0.05)。ROC曲线分析结果显示,D-RSBI联合MIP预测撤机成功的AUC为0.933,优于D-RSBI(0.759)和MIP(0.899)单独预测,且两者联合预测的特异度高于单一指标。结论D-RSBI和MIP对机械通气患者撤机结局均有较好的预测价值,且两者联合预测效果更佳。Objective To investigate the predictive value of diaphragmatic shallow fast breathing index(D-RSBI)combined with maximum inspiratory pressure inspiratory pressure(MIP)for withdrawal of mechanical ventilation.Methods Sixty-eight patients admitted in ICU of Pinghu First People's Hospital from September 2022 to September 2023 who underwent spontaneous breathing trial(SBT)for withdrawl of mechanical ventilation were included in the study.Diaphragmatic displacement and MIP were measured after 30 minutes of SBT,and the respiratory rate was recorded for calculating D-RSBI.Patients were divided into extubation success group and extubation failure group based on extubation outcome.The predictive efficacy of D-RSBI,MIP,and their combination for extubation outcome was evaluated using ROC curves.Results Among the 68 patients,18 cases(26.47%)failed extubation,while 50 cases(72.53%)succeeded.The extubation failure group had higher respiratory rate,D-RSBI,and lower diaphragmatic displacement and MIP than those in the extubation success group(all P<0.05).ROC curve analysis showed that the combination of D-RSBI with MIP had a higher predictive value for successful outcomes of extubation(AUC=0.933)than D-RSBI(0.759)or MIP(0.899)alone,and the specificity of the combined prediction was higher than that of single index.Conclusion Both D-RSBI and MIP have good predictive value for withdrawl of mechanical ventilation in ICU patients,while their combination has a even better prediction efficacy.

关 键 词：膈肌超声 膈肌浅快呼吸指数 最大吸气压力 机械通气 撤机 

分 类 号：R459.7[医药卫生—急诊医学]