膈肌超声预测神经重症气管切开患者堵管耐受试验结局的临床研究  

Clinical study on predicting outcomes of the tracheostomy tube capping trials in patients with severe neuropathy using diaphragmatic ultrasound

作　　者：李清华 关晨霞[1] Li Qinghua;Guan Chenxia(Department of Rehabilitation Medicine,Fifth Affiliated Hospital of Zhengzhou University,Zhengzhou 450052,China)

机构地区：[1]郑州大学第五附属医院康复医学科,郑州450052

出　　处：《中国康复》2025年第4期212-216,共5页Chinese Journal of Rehabilitation

基　　金：河南省科技攻关项目(252102311007)。

摘　　要：目的:探讨膈肌超声用于预测康复科神经重症气管切开患者堵管耐受试验结局的价值。方法:选取48例拟行堵管耐受试验的神经重症气管切开患者,堵管前测量患者的膈肌指标,包括膈肌移动度(DE)、吸气末膈肌厚度(DTei)、呼气末膈肌厚度(DTee)、吸气时间等膈肌指标,并计算膈肌增厚分数(DTF)、膈肌位移-时间指数(E-T指数)。根据堵管耐受试验结果将患者分为成功组31例和失败组17例,比较2组膈肌指标,并建立受试者工作特征曲线(ROC曲线)分析膈肌超声指标对堵管耐受试验结局的预测价值。结果:成功组DTF、E-T指数均高于失败组(P<0.05)。DTF、E-T指数预测堵管耐受试验结局成功的曲线下面积(AUC)分别为0.769、0.738,二者联合预测的AUC为0.793,敏感度为80.6%,特异度为70.6%。结论:DTF、E-T指数可用于预测堵管耐受试验成功结局,二者联合预测价值优于单个参数。Objective:To explore the value of diaphragmatic ultrasound in predicting the outcome of the tracheostomy tube capping trials in patients with severe neuropathy in rehabilitation department.Methods:A total of 48 patients with severe neuropathy who were scheduled to undergo the tracheostomy tube capping trials were selected.Before the trials,the diaphragm excursion(DE),diaphragm thickness at end inspiratory(DTei),diaphragm thickness at end expiratory(DTee),inspiratory time and other diaphragm indicators were measured,and excursion-time(E-T)index was calculated.Based on the results of the trials,the patients were divided into two groups:31 patients in the successful group and 17 patients in the failure group.A comparison of the diaphragm indexes between the two groups was conducted,and the receiver operating characteristic(ROC)curve was established to analyze the predictive value of potential diaphragm ultrasound indexes for the successful outcome of the tracheostomy tube capping trials.Results:The DTF and E-T indexes in the successful group were higher than those in the failure group(P<0.05).The AUC of DTF and E-T index for predicting the successful outcome of the tracheostomy tube capping trials was 0.769 and 0.738,respectively.The combined predictive value of the two indexes was higher,with an AUC of 0.793,a sensitivity of 80.6%,and a specificity of 70.6%.Conclusion:DTF and E-T index can be used to predict the successful outcome of the tracheostomy tube capping trials,and the combined prediction value of the two is superior to a single parameter.

关 键 词：气管切开 神经重症 膈肌超声 堵管 

分 类 号：R49[医药卫生—康复医学] R445.1[医药卫生—临床医学]