重症超声膈肌增厚分数及浅快呼吸指数在机械通气脱机中的应用  

The application of diaphragm thickening fraction and shallow fast respiratory index in mechanical ventilation weaning

作　　者：鄢志磊 陈翠平 钟盛华 YAN Zhilei;CHEN Cuiping;ZHONG Shenghua(ICU,Fuzhou First People's Hospital,Fuzhou,Jiangxi,344000,China)

机构地区：[1]抚州市第一人民医院ICU,江西抚州344000

出　　处：《当代医学》2024年第8期146-149,共4页Contemporary Medicine

摘　　要：目的研究重症超声膈肌增厚分数(DTF)及浅快呼吸指数(RSBI)在机械通气脱机中的应用价值。方法选取2022年1月至2023年1月于抚州市第一人民医院ICU接受机械通气治疗的95例患者作为研究对象,根据患者撤机成功与否分为研究组(撤机成功,n=48)与对照组(撤机失败,n=47)。所有患者均接受自主呼吸试验,并记录相应数据,在重症超声临床应用技术下计算DTF和RSBI。比较两组脱机前的机械通气时间、呼吸频率(RR)、潮气量(VT)、膈肌移动度(DD)、DTF与RSBI,探讨DTF、RSBI单独及其联合应用对脱机结局的预测效能。结果两组械通气时间、VT及DD比较差异无统计学意义;研究组RR、RSBI低于对照组,DTF高于对照组,差异有统计学意义(P<0.05)。绘制ROC曲线,当DTF≥26.72%时,预测脱机成功的灵敏度及特异度分别为66.67%和85.11%,AUC为0.815;当RSBI≤58.75次/(min·L)时,预测脱机成功的灵敏度及特异度分别为79.17%和76.60%,AUC为0.792;DTF联合RSBI预测脱机成功的灵敏度及特异度分别为93.75%和89.36%,AUC为0.895。结论DTF联合RSBI可有效评估预测机械通气脱机时机,提高脱机成功的预测作用。Objective To study the application value of diaphragm thickening fraction(DTF)and shallow fast respiratory index(RSBI)in me-chanical ventilation weaning.Methods 95 patients who received mechanical ventilation treatment in the intensive care unit(ICU)of Fuzhou First People's Hospital from January 2022 to January 2023 were selected as the research subjects,they were divided into the study group(successful with-drawal,n=48)and the control group(unsuccessful withdrawal,n=47)according to the success of withdrawal.All patients underwent spontaneous breathing test and recorded the corresponding data,the DTF and RSBI were calculated under the clinical application technology of severe ultrasound.The mechanical ventilation time,respiratory rate(RR),tidal volume(VT),diaphragm mobility(DD),DTF and RSBI were compared between the two groups,the prediction efficiency of DTF and RSBI on offline outcome after single and combined application were explored.Results There were no significant differences in mechanical ventilation time,VT and DD between the two groups,RR and RSBI in the study group were lower than those in the control group,DTF was higher than those in the control group,the differences were statistically significant(P<0.05).The ROC curve was plotted,when DTF≥26.72%,the sensitivity and specificity for predicting offline success were 66.67%and 85.11%,respectively,and AUC was 0.815;when RSBI≤58.75 times/(min·L),the sensitivity and specificity for predicting offline success were 79.17%and 76.60%,respectively,and AUC was 0.792;the sensitivity and specificity of DTF combined with RSBI in predicting successful weaning were 93.75%and 89.36%,respectively,and the AUC was 0.895.Conclusion DTF combined with RSBI can effectively evaluate and predict the offline time of mechanical ventilation,and im-prove the predictive effect of offline success.

关 键 词：重症 超声 膈肌增厚分数 浅快呼吸指数 机械通气 脱机 

分 类 号：R563.8[医药卫生—呼吸系统]