心肺膈肌联合超声在儿童完全型肺静脉异位引流术后机械通气脱机中的临床价值  

Application value of cardiopulmonary combined diaphragm ultrasound in predicting the weaning from mechanical ventilation in patients of total anomalous pulmonary venous connection(TAPVC)after cardiac surgery in children

作　　者：莫莹 王强[1] 李刚[1] 丁文虹[1] Mo Ying;Wang Qiang;Li Gang;Ding Wenhong(Department of Pediatric Cardiac Center,Beijing 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小儿心脏中心,北京100029

出　　处：《中华胸心血管外科杂志》2024年第10期599-606,共8页Chinese Journal of Thoracic and Cardiovascular Surgery

基　　金：北京市自然科学基金(7222044)。

摘　　要：目的探讨心肺膈肌联合超声在儿童完全型肺静脉异位引流(TAPVC)外科矫治手术后机械通气脱机评估中的临床应用价值。方法选取2020年1月至2023年9月北京安贞医院收治的TAPVC手术患者105例,中位年龄6个月,其中男61例,女44例。术前常规行超声心动图检查,同时记录年龄、体质量、性别、手术体外循环、主动脉阻断等临床指标。并于术后患者成功通过自主呼吸试验后即刻行床旁心肺膈肌联合超声检查,超声测量包括房间隔缺损大小、左心室舒张期末内径、左心室射血分数、右心室面积变化分数、三尖瓣环收缩期位移、肺静脉流速、肺超声评分及膈肌厚度变化率等情况,根据是否脱机分为脱机成功组(78例)和脱机失败组(27例)。均数比较采用t检验;中位数比较采用Mann-Whitney U检验;计数资料采用Pearsonχ^(2)检验。通过单变量分析确定预测脱机失败中差异有统计学意义的参数,并纳入多变量logistic回归分析中寻找独立预测参数,以两组间差异有统计学意义的超声参数分别绘制受试者工作特征(ROC)曲线,再联合各指标综合绘制ROC曲线。结果脱机失败组患者年龄、体质量、术前左心室舒张期末内径、房间隔缺损内径均较脱机成功组小,差异有统计学意义(P<0.05)。脱机失败组体外循环和主动脉阻断均较脱机成功组长,差异有统计学意义(P<0.05)。两组患者性别和术前肺静脉流速差异无统计学意义(P>0.05)。多因素logistic回归分析显示术后左心室射血分数、肺静脉流速、肺超声评分及膈肌厚度变化率均与脱机失败发生显著相关(P<0.05),ROC曲线下面积(AUC)分别为0.736、0.761、0.868、0.829(P<0.05),最佳截断值分别为0.50、160 cm/s、14分及27%。床旁心肺膈肌联合超声指标预测脱机失败的AUC为0.966,敏感性96.3%,特异性89.9%,预测效能显著高于其他超声指标。结论心肺膈肌联合超声对预测完全型肺静�Objective:To investigate the role of cardiopulmonary combined diaphragm ultrasound in predicting the weaning from mechanical ventilation in patients of total anomalous pulmonary venous connection after cardiac surgery in children.Methods:105 patients with TAPVC after cardiac surgery were included and admitted to Beijing Anzhen Hospital from January 2020 to September 2023,and median age was 6 months,including 61 males and 44 females.Echocardiography was routinely performed before surgery,clinical indicators such as age,weight,sex,cardiopulmonary bypass,activated coagulation time were recorded at the same time.And bedside cardiopulmonary combined diaphragm ultrasound was performed after the patient successfully passed the spontaneous breathing test.Ultrasound measurements include atrial septal defect diameter,left ventricular end-diastolic diameter,left ventricular ejection fraction,right ventricular area change fraction,tricuspid annular plane systolic excursion,pulmonary venous diameter,pulmonary ultrasound score,and diaphragm thickening fraction,According to whether the offline was successful,patients were divided into two groups:successful extubation group(78 cases)and extubation failure group(27 cases).The t-test was used for mean comparison.The Mann-Whitney U test was used for median comparison.Pearsonχ^(2) test was used for counting data.Univariate analysis was used to determine the parameters with significant statistical differences in predicted weaning failure,and multivariate logistic regression analysis was included to find independent prediction parameters.The statistical parameters between the two groups were used to draw the receiver operating characteristic curves,and then the ROC curves were comprehensively plotted by the combining indexes.Results:The age,weight,left ventricular diastolic diameter,and atrial septal defect diameter of the the failure group were smaller than those in the weaning group,and the differences were statistically significant(P<0.05).There were statistically significant diff

关 键 词：完全型肺静脉异位引流 超声心动图 肺超声 先天性心脏病 

分 类 号：R445.1[医药卫生—影像医学与核医学] R726.5[医药卫生—诊断学]