心肺膈超声一体化预测重症机械通气患者撤机失败的影响因素  

Influencing Factors of Cardiopulmonary Diaphragmatic Ultrasound Integration in Predicting Weaning Failure in Patients with Severe Mechanical Ventilation

作　　者：黄日林 谢丽玲 陈燕玲 黄贵廉 陈响文 HUANG Rilin;XIE Liling;CHEN Yanling;HUANG Guilian;CHEN Xiangwen(Department of Ultrasound Medicine,the Fifth People's Hospital of Zhuhai,Zhuhai 519055,Guang-dong,China;Department of Intensive Care Medicine,the Fifth People's Hospital of Zhuhai,Zhuhai 519055,Guangdong,China)

机构地区：[1]珠海市第五人民医院超声医学科,广东珠海519055 [2]珠海市第五人民医院重症医学科,广东珠海519055

出　　处：《世界复合医学(中英文)》2024年第12期114-119,共6页World Journal of Complex Medicine

基　　金：珠海市医学科研项目(2220009000230)。

摘　　要：目的评价心肺膈超声一体化预测重症机械通气患者撤机失败的影响因素。方法选取2023年6月—2024年7月在珠海市第五人民医院接受治疗的132例机械通气患者为研究对象,根据撤机成功与否分为撤机成功组(84例)和撤机失败组(48例)。采用单因素及多因素Logistic回归分析分析心肺隔超声一体化预测重症机械通气患者撤机时机。结果撤机成功组的左室射血分数、二尖瓣E峰流速、二尖瓣环室间隔速度、三尖瓣环收缩期位移、三尖瓣环收缩期峰流速、右室面积变化率均高于撤机失败组,差异均有统计学意义(P均<0.05)。两组自主呼吸试验0 min时肺超声评分比较,差异无统计学意义(P>0.05);撤机成功组自主呼吸试验30 min时肺超声水肿评分为(2.47±0.66)分,自主呼吸试验0 min与30min时肺超声水肿评分的差值为(0.96±0.25)分,均低于撤机失败组的(5.98±1.19)分、(5.13±1.64)分,差异均有统计学意义(t=-11.362、-21.348,P均<0.05)。撤机成功组的双侧膈肌厚度、膈肌增厚率、膈肌移动度、呼吸频率均高于撤机失败组,差异均有统计学意义(P均<0.05)。多因素Logistic回归分析结果显示,左室射血分数、右室面积变化率、自主呼吸试验0 min与30 min时肺超声水肿评分的差值、双侧膈肌增厚率为重症机械通气患者撤机失败的影响因素(P均<0.05)。结论心肺膈超声一体化能实现对重症机械通气患者撤机时机的判断,其敏感指标主要为左室射血分数、右室面积变化率、自主呼吸试验0 min与30 min时肺超声水肿评分的差值、双侧膈肌增厚率,关注这些指标的变化,可更好地指导安全撤机。Objective To evaluate the influencing factors of Cardiopulmonary Diaphragmatic ultrasound in-tegration in predicting the failure of weaning timing in patients with severe mechanical ventilation.Methods A total of 132 patients with mechanical ventilation who were treated in the Fifth People's Hospital of Zhuhai from June 2023 to July 2024 were selected as the study subjects.According to the success of weaning,they were di-vided into successful weaning group(84 cases)and failure weaning group(48 cases).Univariate and multivari-ate Logistic regression analysis were used to analyze the integrated cardiopulmonary ultrasound to predict the timing of weaning in patients with severe mechanical ventilation.Results The left ventricular ejection fraction,mitral E peak velocity,mitral annulus interventricular septum velocity,tricuspid annular plane systolic excur-sion,tricuspid annulus peak systolic velocity and fractional area change in the successful weaning group were higher than those in the failure weaning group,and the differences were statistically significant(all P<0.05).There was no significant difference in lung ultrasound edema score between the two groups at 0 min of spontane-ous breathing test(P>0.05).The lung ultrasound edema score at 30 min of spontaneous breathing test in the suc-cessful weaning group was(2.47±0.66)points,and the difference between the lung ultrasound score at 0 min and 30 min of spontaneous breathing test was(0.96±0.25)points,which were lower than(5.98±1.19)points,(5.13±1.64)points in the failure weaning group,the differences were statistically significant(t=-11.362,-21.348,both P<0.05).The bilateral diaphragm thickness,diaphragm thickening fraction,diaphragmatic excur-sion and respiratory rate in the successful weaning group were higher than those in the failure weaning group,and the differences were statistically significant(all P<0.05).Multivariate Logistic regression analysis showed that left ventricular ejection fraction,fractional area change,the difference of lung ultrasound edema

关 键 词：心肺膈超声一体化 重症患者 机械通气 撤机时机 

分 类 号：R563.5[医药卫生—呼吸系统]