膈肌浅快呼吸指数与L3骨骼肌指数对老年重症肺炎患者撤机结局的预测价值  

Predictive Value of Diaphragm Rapid Shallow Breathing Index and L3 Skeletal Muscle Index on Weaning Outcomes of Elderly Patients with Severe Pneumonia

作　　者：王得恩 秦小芳 杨薇 WANG Deen;QIN Xiaofang;YANG Wei(Departments of Geriatrics,Huai’an First People’s Hospital,Huai’an,Jiangsu 223300,China;Department of Ultrasound,Huai’an First People’s Hospital,Huai’an,Jiangsu 223300,China)

机构地区：[1]南京医科大学附属淮安第一医院老年科,江苏淮安223300 [2]南京医科大学附属淮安第一医院超声科,江苏淮安223300

出　　处：《临床肺科杂志》2025年第5期726-731,共6页Journal of Clinical Pulmonary Medicine

基　　金：淮安市科技项目(HAP202105)。

摘　　要：目的探究膈肌浅快呼吸指数(diaphragm rapid shallow breathing index,D-RSBI)与L3骨骼肌指数(skeletal muscle index at the third lumber vertebra,L3 SMI)对老年重症肺炎患者撤机结局的预测价值。方法收集2023年1月至2023年12月南京医科大学附属淮安第一医院收治的96例老年重症肺炎患者的临床资料,根据撤机结局分为撤机成功组和和失败组。两组患者均进行D-RSBI评估并检测L3 SMI水平。比较两组患者的临床资料、D-RSBI和L3 SMI水平。Logistic回归分析用于明确老年重症肺炎患者撤机失败的影响因素并基于回归分析结果构建列线图模型。通过受试者工作特征曲线(Receiver Operating Characteristic,ROC)分析L3 SMI联合D-RSBI对老年重症肺炎患者撤机失败的预测价值。结果96例老年重症肺炎机械通气患者中60例患者撤机成功,36例撤机失败,撤机失败率为37.5%。相较于撤机成功组,撤机失败组的机械通气时间和D-RSBI水平均增高,L3 SMI水平降低(P<0.05)。Logistic结果显示机械通气时间、D-RSBI是老年重症肺炎患者撤机失败的危险因素,而L3 SMI水平是老年重症肺炎患者撤机失败的保护因素(P<0.05)。预测老年重症肺炎患者撤机失败的列线图模型一致性指数(C-index)为0.794,校准曲线拟合良好。ROC分析显示L3 SMI水平评估老年重症肺炎患者撤机失败的AUC为0.788,95%CI为0.697~0.879,D-RSBI的AUC为0.748,95%CI为0.637~0.859,二者联合预测的AUC为0.819,95%CI为0.738~0.901。结论D-RSBI与L3 SMI联合使用对老年重症肺炎患者撤机失败的预测价值更高。Objective To explore the predictive value of diaphragm rapid shallow breathing index(D-RSBI)and skeletal muscle index at the third lumbar vertebra(L3 SMI)on weaning outcomes of elderly patients with severe pneumonia.Methods Clinical data of 96 elderly patients with severe pneumonia admitted to Huai′an First Hospital Affiliated with Nanjing Medical University from January 2023 to December 2023 were collected.Based on the results of the weaning procedure,the patients were categorized into the successful weaning group and the failed weaning group.Both groups were assessed for D-RSBI and tested for L3 SMI levels.Clinical data,D-RSBI,and L3 SMI levels were compared between the two groups.Logistic regression analysis was used to identify the influencing factors of weaning failure in elderly patients with severe pneumonia and construct a nomogram model based on the regression analysis results.Receiver Operating Characteristic(ROC)analysis was performed to evaluate the predictive value of L3 SMI combined with D-RSBI for weaning failure in elderly patients with severe pneumonia.Results Among the 96 elderly patients with severe pneumonia requiring mechanical ventilation,60 patients had successful weaning,and 36 had failed weaning,with a weaning failure rate of 37.5%.In comparison to the group that successfully underwent weaning,the patients in the failed weaning group exhibited significantly prolonged mechanical ventilation durations and elevated D-RSBI levels,while demonstrating a reduced L3 SMI level(P<0.05).The logistic results show that the duration of mechanical ventilation and D-RSBI are risk factors for extubation failure in elderly patients with severe pneumonia,while the L3 SMI level was a protective factor against extubation failure in elderly patients with severe pneumonia(P<0.05).The consistency index(C-index)of the nomogram model for predicting weaning failure in elderly patients with severe pneumonia was 0.794,and the calibration curve fitted well.ROC analysis showed that the AUC of L3 SMI for predicting we

关 键 词：膈肌浅快呼吸指数 L3骨骼肌指数 重症肺炎 撤机 

分 类 号：R563.1[医药卫生—呼吸系统]