肺部超声联合下腔静脉呼吸变异率对有创机械通气脱机指征评估的临床应用  

Clinical Application of Pulmonary Ucombined with Inferior Vena Cava Respiratory Variation Rate to Evaluate the Offline Indication of Invasive Mechanical Ventilation

作　　者：王瑶 王俊 赵小东[1] 钱骏[1] 廖文超 冯国隽[1] Wang Yao;Wang Jun;Zhao Xiaodong(Department of Ultrasound Medicine,Jiangyou People's Hospital,Jiangyou,Sichuan 621700;Respiratory Department,Chengdu Sixth People's Hospital,Chengdu,Sichuan 610000,China)

机构地区：[1]江油市人民医院超声医学科,重症医学科,四川江油621700 [2]成都市第六人民医院呼吸科,四川成都610000

出　　处：《四川医学》2025年第3期312-315,共4页Sichuan Medical Journal

基　　金：江油市科学技术局科研课题(编号:2021-34)。

摘　　要：目的探讨肺部超声结合下腔静脉呼吸变异率评估对有创呼吸机辅助通气治疗后期脱机的临床指导意义。方法选取我院2019年1月至2022年10月有创机械通气达72 h的患者78例,分常规组41例,行自主呼吸试验(SBT)后进入脱机程序;超声组37例,行肺部超声及下腔静脉变异率检测,达标且通过SBT后脱机拔管;脱机后48 h不再进行有创或无创机械通气为脱机成功。记录上机前肺部超声评分、脱机前机械通气时间、APACHEⅡ评分、GCS评分、氧合指数、pH值,以及2 d、5 d和9 d的脱机成功率。结果除上机前肺超声评分外,两组间年龄、性别、机械通气时间、APACHEⅡ评分、GCS评分、氧合指数、pH值等各特征差异均无统计学意义(均P>0.05);超声组和常规组的2 d脱机成功率分别为75.7%和48.8%,5 d脱机成功率分别为62.2%和31.7%,9 d脱机成功率分别为45.9%和24.4%,差异均有统计学意义(P<0.05)。结论肺部超声结合下腔静脉呼吸变异率评估能有效指导有创机械通气患者脱机,提高安全性。Objective To investigate the clinical significance of pulmonary ultrasound combined with the evaluation of the respiratory variation rate of inferior vena cava in the treatment of late off-line treatment with invasive ventilator-assisted ventilation.Methods A total of 78 patients with invasive mechanical ventilation for 72 h from January 2019 to October 2022 in our hospital were selected,and 41 patients were divided into routine group.They underwent spontaneous breathing test(SBT)and then entered the offline program.In the ultrasound group,37 cases were detected by pulmonary ultrasound and the variation rate of inferior vena cava.After reaching the standard and passing SBT,extubation was performed.If no invasive or non-invasive mechanical ventilation is performed 48 h after offline,the offline is successful.Pulmonary ultrasound score,mechanical ventilation time,APACHEⅡscore,GCS score,oxygenation index,pH value,and off-line success rate at day 2,day 5 and day 9 were recorded.Results Except pulmonary ultrasound score,there were no significant differences in age,gender,mechanical ventilation time,APACHEⅡscore,GCS score,oxygenation index and pH value between the two groups(all P>0.05).The success rates of 2-day offline were 75.7%and 48.8%in the ultrasound group,62.2%and 31.7%in the 5-day offline group,and 45.9%and 24.4%in the 9-day offline group,respectively,with statistically significant differences between the two groups(P<0.05).Conclusion Pulmonary ultrasound combined with the evaluation of respiratory variation rate of inferior vena cava can effectively guide patients with invasive mechanical ventilation offline and improve safety.

关 键 词：肺部超声 下腔静脉呼吸变异率 机械通气 脱机 

分 类 号：R445.1[医药卫生—影像医学与核医学]