摘要
目的探讨浅快呼吸指数(RSBI)、膈肌移动度(DD)和膈肌增厚率(DTF)对重症肺炎机械通气患者撤机的指导价值。方法选择浙江省杭州市余杭区第一人民医院2018年6月-2019年6月需接受机械通气治疗的重症肺炎患者62例,均采取自主呼吸试验(SBT),根据撤机结局将其分为撤机成功组(44例)和撤机失败组(18例),将APACHEII评分、机械通气时间、RR、RSBI、DD和DTF等指标纳入单因素分析和多因素Logistic回归分析,得出影响重症肺炎通气撤机成功的独立因素;绘制ROC曲线,评价RSBI、DD、DTF单独或联合检测对撤机成功的预测价值。结果经单因素及多因素Logistic回归分析,APACHEⅡ评分、RSBI、DD、DTF是影响撤机成功的独立因素;RSBI、DD、DTF的ROC曲线下面积(AUC)分别为0.82、0.85、0.88,均小于以RSBI≤62.2次/(L·min)、DD≥12.8mm、DTF≥28.6%为临界值的联合指标AUC 0.93,其诊断特异度为90.04%,敏感度为85.28%。结论联合检测RSBI、DD、DTF对预测重症肺炎成功撤机的效果更好;而在单一检测指标中,DTF具有更好的预测作用。
Objective To study the guiding value of rapid shallow breuting index(RSBI)、diaphragmatic displcuement(DD)and diaphragm thickening fraction(DTF)on the mechanical ventilation withdrawal of severe pneumonia.Methods A total of 62 severe pneumonia patients requiring mechanical ventilation in our hospital from June 2018 to June 2019 were se-lected.All patients underwent spontaneous breathing test(SBT),and were divided into the successful weaning group(44 cases)and the failed weaning group(18 cases)according to the weaning outcome.RSBI within 30 min of SBTand RIGHT DD and DTF measured by ultrasound were observed and compared between the two groups.ROC curve was drawn to evaluate the predictive value of RSBI,DD and DTF alone or jointly for the success of decommission.Results RSBI in the successful weaning group was significantly lower than that in the failed weaning group,while DD and DTF were significantly higher than those in the failed weaning group,with statistical significance(P<0.05).The areas under ROC curve(AUC)of RSBI,DD and DTF were 0.82,0.85 and 0.88,respectively,which were all smaller than 0.93 of the combined index with RSBI≤62.2 times/(L·min)、DD≥12.8 mm and DTF≥28.6%as the critical values.The diagnostic sensitivity was 90.04%(P<0.05),and the diagnostic sensitivity was 85.28%.Conclusion RSBI、DD and DTF can all be used as indicators to predict the withdrawal rate of severe pneumonia patients,and the combined detection of the three is better in predicting the success rate of withdrawal.
作者
林一娟
杨姝婷
LIN Yijuan;YANG Shuting(Hangzhou Yuhang First People's Hospital,Hangzhou 311100,China)
出处
《浙江实用医学》
2021年第2期91-94,共4页
Zhejiang Practical Medicine
关键词
机械通气撤机
浅快呼吸指数
膈肌移动度
膈肌增厚率
weaning from mechanical ventilation
rapid shallow breating index
diaphragmatic displacement
diaphragm thickening fraction
