膈肌超声参数联合浅快呼吸指数预测神经重症机械通气患者撤机结局的临床价值  

Clinical value of diaphragmatic ultrasound parameters combined with rapid shallow breathing index in predicting weaning outcomes from mechanical ventilation in neurocritical patients

作　　者：廖利萍[1,2] 高英 徐磊[1] 艾山木[3] 王科 陈鹏[1] 邓永兵 吴晓苏[1] 黄翠 LIAO Liping;GAO Ying;XU Lei;AI Shanmu;WANG Ke;CHEN Peng;DENG Yongbing;WU Xiaosu;HUANG Cui(Department of Neurosurgery,Chongqing Emergency Medical Center,Chongqing 400014,China;School of Nursing,Chengdu University of Traditional Chinese Medicine,Chengdu 610000,China;Department of Emergency Medicine,Chongqing Emergency Medical Center,Chongqing 400014,China)

机构地区：[1]重庆市急救医疗中心神经外科,重庆400014 [2]成都中医药大学护理学院,四川成都610000 [3]重庆市急救医疗中心急诊医学科,重庆400014

出　　处：《临床超声医学杂志》2025年第4期307-313,共7页Journal of Clinical Ultrasound in Medicine

基　　金：重庆市科卫联合医学科研项目(2024MSXM145)。

摘　　要：目的探讨膈肌超声参数联合浅快呼吸指数(RSBI)预测神经重症机械通气患者撤机结局的临床价值。方法选取我院机械通气超过48 h且符合撤机标准拟行撤机的神经重症患者145例,根据撤机后48 h患者呼吸状况分为撤机成功组89例和撤机失败组56例,比较两组自主呼吸试验前呼吸力学参数、RSBI,以及膈肌超声参数[膈肌移动度(DE)和膈肌增厚率(DTF)]的差异。采用单因素及多因素Logistic回归分析筛选预测神经重症机械通气患者撤机结局的影响因素;绘制受试者工作特征(ROC)曲线分析各参数单独及联合应用预测神经重症机械通气患者撤机结局的诊断效能。结果撤机失败组RSBI高于撤机成功组,DE、DTF均低于撤机成功组,差异均有统计学意义(均P<0.001)。单因素及多因素Logistic回归分析显示,RSBI、DE、DTF均为预测神经重症机械通气患者撤机结局的独立影响因素(均P<0.05)。ROC曲线分析显示,RSBI、DE、DTF预测神经重症机械通气患者撤机结局的曲线下面积(AUC)分别为0.791、0.777、0.805,灵敏度分别为89.29%、80.36%、76.79%,特异度分别为65.17%、65.17%、88.76%;RSBI联合DE、RSBI联合DTF、DE联合DTF及三者联合应用预测神经重症机械通气患者撤机结局的AUC分别为0.873、0.878、0.868、0.917,以三者联合应用的AUC最高,与其余方法比较差异均有统计学意义(均P<0.05)。结论膈肌超声参数联合RSBI在预测神经重症机械通气患者撤机结局中具有较高的临床价值。Objective To investigate the clinical value of diaphragmatic ultrasound parameters combined with rapid shallow breathing index(RSBI)in predicting weaning outcomes from mechanical ventilation in neurocritical patients.Methods A total of 145 neurocritical patients who received mechanical ventilation for over 48 h and met weaning criteria were enrolled.According to the respiratory status within 48 h post-weaning,patients were divided into successful weaning group(89 cases)and failed weaning group(56 cases).The differences in respiratory mechanics parameters before sponta neous breathing trial,RSBI,and diaphragmatic ultrasound parameters[diaphragmatic excursion(DE)and diaphragmatic thickening fraction(DTF)]were compared between the two groups.Univariate and multivariate Logistic regression analysis were performed to screen the influencing factors for predicting weaning outcomes from mechanical ventilation in neurocritical patients.Receiver operating characteristic(ROC)curve was drawn to analyze the diagnostic efficacy of individual and combined parameters in predicting the meaning outcomes from mechanical ventilation in neurocritical patients.Results The failed weaning group exhibited higher RSBI and lower DE and DTF than those of the successful group(all P<0.001).Univariate and multivariate Logistic regression analysis revealed that RSBI,DE and DTF were all independent influencing factors for predicting weaning outcomes from mechanical ventilation in neurocritical patients(all P<0.05).ROC curve analysis showed that the area under the curve of RSBI,DE and DTF in predicting the weaning outcomes from mechanical ventilation in neurocritical patients were 0.791,0.777 and 0.805,with sensitivities of 89.29%,80.36%and 76.79%,and specificities of 65.17%,65.17%and 88.76%,respectively.The combination of RSBI with DE,RSBI with DTF,DE with DTF,and all three parameters yielded AUCs of 0.873,0.878,0.868 and 0.917,respectively,with the highest AUC achieved by the three-parameter combination,the differences were statistically signif

关 键 词：超声检查 膈肌 浅快呼吸指数 神经重症 机械通气 撤机结局 

分 类 号：R445.1[医药卫生—影像医学与核医学]