超声心动图联合膈肌超声对心脏瓣膜置换术机械通气患者撤机结局的预测研究  

Study on the prediction of echocardiography combined with diaphragmatic ultrasound on the outcome of removing machine for patients with cardiac valve replacement for mechanical ventilation

作　　者：姚易兰 周承 凌生林[3] 韩江涛[1] 余俊隆 毕红亲 Yao Yilan;Zhou Cheng;Ling Shenglin;Han Jiangtao;Yu Junlong;Bi Hongqin(Department of Ultrasonography,The First People's Hospital of Yibin,Yibin 644000,China;Department of Intensive Care Unit,The First People's Hospital of Yibin,Yibin 644000,China;Department of Thoracic and Cardiac Surgery,The First People's Hospital of Yibin,Yibin 644000,China)

机构地区：[1]宜宾市第一人民医院超声科,宜宾644000 [2]宜宾市第一人民医院重症监护室,宜宾644000 [3]宜宾市第一人民医院胸心外科,宜宾644000

出　　处：《中国医学装备》2024年第8期70-74,90,共6页China Medical Equipment

基　　金：四川省卫生健康科研基金(22SYJS21)。

摘　　要：目的:分析超声心动图联合膈肌超声对心脏瓣膜置换术机械通气患者撤机结局的预测价值。方法:回顾性选择2022年1月至2023年3月宜宾市第一人民医院住院部收治并行心脏瓣膜置换术后机械通气的57例患者,根据撤机结果,拔管前30 min对患者行自主呼吸试验(SBT),将撤机48 h后再次插管或气道切开SBT失败的11例患者纳入撤机失败组;撤机48 h内存活且无需任何呼吸机支持SBT成功的46例患者纳入撤机成功组。所有患者均接受超声心动图联合膈肌超声检查,比较不同撤机结局组间左室射血分数(LVEF)、右室面积变化分数(RVFAC)及二尖瓣瓣环侧壁收缩速度(Sa)等超声心动图指标,以及记录二尖瓣环根部舒张早期峰值(e')计算二尖瓣舒张早期血流速度峰值(E)与e'比值(E/e')及超声心动图指标与膈肌超声指标,行logistic回归分析影响撤机失败因素,绘制受试者工作特征(ROC)曲线,预测超声心动图指标与膈肌超声指标在机械通气撤机失败中的预测价值。结果:撤机成功组LVEF差值、RVFAC差值及Sa差值与撤机失败组比较,差异均无统计学意义(P>0.05);撤机成功组E/e'为10.06±1.30,低于撤机失败组的12.69±2.86,组间比较差异有统计学意义(t=2.084,P<0.05);撤机成功组膈肌增厚率(DTF)和膈肌活动度(DE)值为(41.34±10.74)和(13.04±1.18),均显著高于撤机失败组的(19.67±5.37)和(11.27±0.94),组间比较差异有统计学意义(t=2.148、2.776,P<0.05);logistic回归分析结果显示,DTF、DE低水平表达,E/e'高水平表达均为心脏瓣膜置换术机械通气患者撤机失败的影响因素;DTF、DE及E/e'的ROC曲线结果显示,预测模型最佳临界值为0.0893,ROC曲线下面积(AUC)为0.713(95%CI:0.646~0.758)、0.710(95%CI:0.651~0.779)、0.752(95%CI:0.657~0.805)和0.886(0.782~0.991)。结论:超声心动图联合膈肌超声可较好地预测撤机结局,具有较高的临床应用价值。Objective:To analyze the predictive value of echocardiography combined with diaphragmatic ultrasound on the outcome of removing machine for patients who underwent cardiac valve replacement for mechanical ventilation.Methods:Retrospectively,a total of 57 patients who adopt mechanical ventilation after underwent cardiac valve replacement in the First People's Hospital of Yibin from January 2022 to March 2023 were selected as the study subjects.According to the results of removing machine,the patients were divided into failed group(11 cases)and successful group(46 cases).All patients underwent echocardiography combined with diaphragmatic ultrasound examination.The indicators of echocardiography,included left ventricular ejection fractions(LVEF),right ventricular fractional area change(RVFAC)and systolic myocardial velocity(Sa),between different groups were compared.The early diastolic mitral annular tissue velocity(e')was recorded to calculate the ratio of early diastolic transmitral flow velocity(E)to e'(E/e'),and the indicators of echocardiography and diaphragmatic ultrasound.Logistic regression analysis was performed to analyze the factors affecting the failure of removing machine.Receiver operating characteristic(ROC)curve was drawn to evaluate the predictive values of echocardiography and diaphragmatic ultrasound indicators for the failure of removing machine in mechanical ventilation.Results:The differences of the differences of LVEF,RVFAC and Sa between failed group and successful group were no significant(P>0.05).The E/e'value of the successful group was 10.06±1.30,which was significantly lower than 12.69±2.96 of the failed group,and the difference was statistically significant(t=2.084,P<0.05).The diaphragm thickening fraction(DTF)and diaphragm excursion(DE)values of the successful group were respectively 41.34±10.74 and 13.04±1.18,which were significantly higher than 19.67±5.37 and 11.27±0.94 of the failed group,respectively,and the differences between the two groups were statistically significant(t=2

关 键 词：超声心动图 膈肌超声 心脏瓣膜置换术 机械通气 撤机结局 预测性分析 

分 类 号：R445.1[医药卫生—影像医学与核医学]