超声测量膈肌活动度及膈肌浅快呼吸指数在预测心力衰竭机械通气患者成功撤机方面的价值  

Value of ultrasound measurements of diaphragmatic mobility and diaphragmatic rapid shallow breathing index in predicting successful withdrawal of mechanically ventilated heart failure patients

作　　者：景莉娟 赵香梅 许丽君 王龙安 秦历杰 JING Li-juan;ZHAO Xiang-mei;XU Li-jun;WANG Long-an;QIN Li-jie(Henan Provincial Peoples Hospital,Peoples Hospital of Zhengzhou University,Peoples Hospital of Henan University,Zhengzhou 450003,China)

机构地区：[1]河南省人民医院,郑州大学人民医院,河南大学人民医院急诊科,郑州450003

出　　处：《医药论坛杂志》2025年第5期466-470,共5页Journal of Medical Forum

基　　金：河南省医学科技攻关计划省部共建项目(SBGJ202003006);河南省医学科技攻关计划联合共建项目(LHGJ20230010);河南省人民医院23456人才工程项目。

摘　　要：目的本研究旨在探讨膈肌活动度(diaphragmatic mobility,DD)与膈肌浅快呼吸指数(diaphragmatic rapid shallow breathing index,D-RBSI)在预测心力衰竭机械通气患者成功撤机中的潜在价值。方法本研究纳入了2022年1月至2024年5月期间,在河南省人民医院急诊重症监护病房接受治疗的70例心力衰竭机械通气患者。所有患者在经过撤机筛查后,采用持续气道正压通气模式进行自主呼吸试验(spontaneous breathing test,SBT)。在SBT开始后的30分钟内或SBT失败时,详细记录患者的呼吸频率(respiratory rate,RR)和潮气量(tidal volume,Vt),并利用床旁超声技术精确测量患者的DD。随后,根据RR与DD的比值(RR/DD)计算出D-RBSI。通过绘制受试者工作特征(receiver operating characteristic,ROC)曲线,系统分析DD、RBSI及D-RBSI在预测心力衰竭机械通气患者成功撤机方面的效能。结果研究结果显示,共有45例患者成功撤机,而25例患者撤机失败。相较于撤机失败组,成功撤机组的患者表现出更低的心率(HR)和RR,同时拥有显著的DD,具体数值为[(23±3)mm vs(17±3)mm,P<0.001]。此外,成功撤机组患者的RBSI及D-RBSI均低于撤机失败组[RBSI:(33±4)次/(min·L)vs(39±5)次/(min·L),P<0.001;D-RBSI:(0.70±0.17)次/(min·mm)vs(1.10±0.29)次/(min·mm),P=0.005]。进一步分析显示,DD、RBSI及D-RBSI在预测成功撤机方面的ROC曲线下面积分别为0.894(95%CI:0.822~0.966)、0.843(95%CI:0.745~0.941)和0.930(95%CI:0.873~0.987)。此外,成功撤机组与失败组患者之间的DD和D-RBSI存在显著相关性(R~2=0.866,P<0.001)。结论在心力衰竭机械通气患者的自主呼吸试验过程中,通过床旁超声技术监测DD及计算D-RBSI,可有效评估患者撤机的成功率,为临床决策提供有力的依据。Objective To investigate the potential value of diaphragmatic mobility(DD)and diaphragmatic rapid shallow breathing index(D-RBSI)in predicting successful withdrawal in mechanically ventilated heart failure patients.Methods Seventy mechanically ventilated heart failure patients treated in Henan Provincial Peoples Hospital acute intensive care unit between January 2022 and May 2024 were included in this study.All patients underwent a spontaneous breathing test(SBT)using continuous positive airway pressure ventilation mode after screening for withdrawal.Patients'respiratory rate(RR)and tidal volume(Vt)were recorded in detail within 30 minutes after the start of SBT or in case of failure of SBT,and patientsDD was measured accurately using bedside ultrasound technology.Subsequently,D-RBSI was calculated based on the ratio of RR to DD(RR/DD).The efficacy of DD,RBSI,and D-RBSI in predicting successful withdrawal of mechanically ventilated heart failure patients was systematically analyzed by plotting the receiver operating characteristic(ROC)curve.Results The results of the study showed that a total of 45 patients were successfully withdrawn from the ventilator,whereas 25 patients failed to be withdrawn from the ventilator.Compared to the failed ventilator withdrawal group,patients in the successful ventilator withdrawal group demonstrated lower heart rate(HR)and RR,while possessing significant DD,with values of[(23±3)mm vs(17±3)mm,P<0.001].In addition,the RBSI and D-RBSI were lower in the patients in the successful withdrawal group than those in the failed withdrawal group[RBSI:(33±4)breaths/(min·L)vs(39±5)breaths/(min·L),P<0.001;D-RBSI:(0.70±0.17)breaths/(min:mm)vs(1.10±0.29)times/(min:mm),P=0.005].Further analysis showed that the area under the R0C curve for DD,RBSI and D-RBSI in predicting successful withdrawal was 0.894(95%CI:0.822-0.966),0.843(95%CI:0.745-0.941)and 0.930(95%Cl:0.873-0.987),respectively.In addition,there was a significant correlation between DD and D-RBSI between patients in the successful

关 键 词：心力衰竭 膈肌活动度 膈肌呼吸浅快指数 机械通气 撤机 

分 类 号：R541.61[医药卫生—心血管疾病]