摘要
目的:评价超声检查膈肌增厚和活动度对机械通气患者撤机结局的预测价值。方法:纳入54例成功通过自主呼吸试验(SBT)的患者进行研究。SBT过程中,采用超声检查评估患者的膈肌活动度、吸气末和呼气末的膈肌厚度(Tdi)以及膈肌增厚分数(DTF%);同时记录常规的撤机参数。撤机后,追踪观察患者48小时。结果:54例患者中,14例(25.9%)患者撤机失败。撤机成功患者的膈肌活动度、吸气末和呼气末Tdi以及DTF%均高于撤机失败的患者,差异有统计学意义(P<0.05)。与撤机成功相关的膈肌指标的临界值为:膈肌活动度≥10.5mm;吸气末Tdi≥21mm;呼气末Tdi≥10.5mm;DTF%≥34.2%。各指标预测撤机成功的敏感性分别为87.5%、77.5%、80.0%和90.0%;特异性分别为71.5%、86.6%、50.0%和64.3%。将膈肌活动度≥10.5mm和吸气末Tdi≥21mm两者结合,预测撤机成功的敏感性降低至64.9%,但特异性升高至100%;浅快呼吸指数(RSBI)<105用于预测撤机成功的敏感性达90.0%,但特异性仅有18.7%。结论:对通过SBT的患者,膈肌活动度和吸气末膈肌厚度的超声评估,是优质的机械通气患者撤机结局的预测指标。因此,推荐考虑使用上述指标和RSBI,以改善撤机结局。
Objective： To evaluate role of diaphragmatic thickening and excursion, assessed ultrasonographically, in predicting extubation outcome. Methods： Fifty-four patients who successfully passed spontaneous breathing trial（SBT） were enrolled. They were assessed by ultrasound during SBT evaluating diaphragmatic excursion, diaphragmatic thickness（Tdi） at end inspiration, at end expiration and diaphragmatic thickness fraction（DTF%）. Simultaneously traditional weaning parameters were recorded. Patients were followed up for 48 h after extubation. Results： Out of 54 included patients, 14（25.9%） failed extubation. Diaphragmatic excursion, Tdi at end inspiration, at end expiration and DTF% were significantly higher in the successful group compared to those who failed extubation（P〈0.05）. Cutoff values of diaphragmatic measures associated with successful extubation were 10.5 mm for diaphragmatic excursion, 21 mm for Tdi at end inspiration, 10.5 mm for Tdi at end expiration, 34.2% for DTF% giving 87.5%, 77.5%, 80.0% and 90.0% sensitivity respectively and 71.5%, 86.6%, 50.0% and 64.3% specificity respectively. Combining diaphragmatic excursion 10.5 mm and Tdi at end inspiration 21 mm decreased sensitivity to 64.9% but increased specificity to 100%. Rapid shallow breathing index（RSBI） 105 had 90.0% sensitivity but 18.7% specificity. Conclusion： Ultrasound evaluation of diaphragmatic excursion and thickness at end inspiration could be a good predictor of extubation outcome in patients who passed SBT. It is recommended to consider the use of these parameters with RSBI consequently to improve extubation outcome.
出处
《中国护理管理》
CSCD
2017年第1期144-144,共1页
Chinese Nursing Management
关键词
超声膈肌
撤机
机械通气
ultrasound
diaphragm
extubation
mechanically rentilation
