DTF-RSBI、DE-RSBI联合呼吸肌功能指标预测高龄重症肺炎机械通气撤机结局的价值研究  

The efficacy and significance of DTF-RSBI,DE-RSBI combined with respiratory muscle function index to predict waning of machanical ventilation in elderly patients with severe pneumonia

作　　者：孙丽颖 王林琳 叶旭辉[1] 余均平 戴李华 SUN Liying;WANG Linlin;YE Xuhui;YU Junping;DAI Lihua(Shanghai Yangpu District East Hospital,Shanghai 200438,China)

机构地区：[1]上海市杨浦区市东医院,上海200438

出　　处：《中国急救复苏与灾害医学杂志》2024年第10期1307-1311,1315,共6页China Journal of Emergency Resuscitation and Disaster Medicine

基　　金：医疗服务与保障能力提升项目(国家临床重点专科,承担疫情重点救治任务医院建设项目)(编号:Z155080000004-02)。

摘　　要：目的使用超声监测高龄重症肺炎(SP)患者膈肌增厚率浅快呼吸指数(DTF-RSBI)、膈肌移动度浅快呼吸指数(DE-RSBI)及其呼吸肌功能指标,探究三者对高龄SP患者机械通气(MV)撤机结局的预测价值。方法回顾性分析上海市杨浦区市东医院2022年10月—2023年10月收治的59例高龄SP患者,均行MV治疗,在满足撤机条件后对其行常规自主呼吸试验(SBT),记录呼吸肌功能指标,采用超声监测并计算高龄SP患者DERSBI、DTF-RSBI。根据撤机结局对患者进行分组,收集一般资料,采用多因素Logistic回归分析影响撤机结局的因素,并绘制受试工作者特征(ROC)曲线分析各指标对高龄SP患者MV撤机结局的预测价值。结果纳入的59例高龄SP患者中,撤机成功患者为42例(71.19%)纳入成功组,撤机失败患者为17例(28.81%)纳入失败组。与失败组相比,成功组体重指数(BMI)、呼吸功能指标最大吸气压(MIP)、MIP%、最大呼气压(MEP)和MEP%均较高,MV时间较短,急性生理和慢性健康评价(APACHE)Ⅱ评分和DTF-RSBI、DE-RSBI较低(P<0.05)。多因素Logistic分析结果显示,BMI、MV时间、APACHEⅡ评分、呼吸频率(RR)、MIP、MIP%、MEP、MEP%、DTF-RSBI和DE-RSBI均是高龄SP患者撤机失败的影响因素(P<0.05)。DTF-RSBI、DE-RSBI及呼吸肌功能指标对高龄SP患者MV撤机结局均有一定预测价值,且联合预测效能最高。结论DE-RSBI、DTF-RSBI及呼吸肌功能指标均能预测高龄SP患者MV撤机结局,且三者联合预测的整体效能最高。Objective To use ultrasound to monitor the diaphragmatic thickening rate,shallow and fast respiratory index(DTF-RSBI),diaphragmatic mobility,shallow and fast respiratory index(DE-RSBI),and respiratory muscle function indicators in elderly patients with severe pneumonia(SP),and to explore the predictive value of these three factors on the outcome of mechanical ventilation(MV)withdrawal in elderly SP patients.Methods A retrospective analysis was conducted on 59 elderly SP patients admitted to our hospital from October 2022 to October 2023.All patients underwent MV treatment and underwent routine spontaneous breathing test(SBT)after meeting the conditions for weaning.Respiratory muscle function indicators were recorded,and ultrasound monitoring was used to calculate the DE-RSBI and DTF-RSBI of elderly SP patients.According to the withdrawal outcome,patients were grouped and general information was collected.Multivariate Logistic analysis was used to analyze the factors that affect the withdrawal outcome,and receiver operating characteristic(ROC)curve was drawn to analyze the predictive value of each indicator on the MV withdrawal outcome of elderly SP patients.Results Among the 59 elderly SP patients included in this study,42(71.19%)were successfully weaned and 17(28.81%)were successfully weaned and included in the failure group.Compared to the failed group.The successful group had higher BMI,respiratory function indicators such as maximum inspiratory pressure(MIP),MIP%,maximum expiratory pressure(MEP),and MEP%,shorter MV time,lower acute physiological and chronic health assessment(APACHE)II scores,DTF-RSBI,and DE-RSBI(P<0.05).The results of multivariate Logistic analysis showed that BMI,MV time,APACHE II score,respiratory rate(RR),MIP,MIP%,MEP,MEP%,DTF-RSBI,and DE-RSBI were all influencing factors for weaning failure in elderly severe SP patients(P<0.05).DTF-RSBI,DE-RSBI,and respiratory muscle function indicators have certain predictive value for MV weaning outcomes in elderly SP patients,and the combined predictiv

关 键 词：重症肺炎 高龄 膈肌移动度浅快呼吸指数 膈肌增厚率浅快呼吸指数 超声 机械通气 

分 类 号：R563.1[医药卫生—呼吸系统]