摘要
目的探讨左室舒张功能不全对左室射血分数（LVEF）〉0．50患者机械通气撤机结果的预测价值。方法采用回顾性病例对照研究方法，分析2014年6月至2016年12月中日友好医院外科重症加强治疗病房（ICU）收治的65例LVEF〉0．50，且机械通气时间至少持续48h后撤机患者的临床资料。收集患者在进行自主呼吸试验（SBT）前的基本资料及超声心动图检查结果，通过二尖瓣口血流充盈指标分析患者左室舒张功能与撤机结果的可能关系。根据超声心动图左室舒张功能分级标准将患者分为左室舒张功能正常组、轻度舒张功能不全（1级）组和中至重度舒张功能不全（2～3级）组，比较各组间患者的撤机结果；根据撤机结果将患者分为撤机成功组和撤机失败组，比较两组间患者的基本资料及左室舒张功能指标。采用受试者工作特征曲线（ROC）评估左室舒张功能对重症患者撤机结果的预测价值。结果65例患者最终均纳入分析，撤机失败28例（43．1％），其中22例为首次SBT失败，6例为拔除气管导管后48h内再次插管。左室舒张功能正常组31例，轻度舒张功能不全组9例，中至重度舒张功能不全组25例；随左室舒张功能不全逐渐加重，患者撤机失败率逐渐增加，分别为16．1％、44．4％、76．0％（Х^2=20．240，P=0．001）。与撤机成功者相比，撤机失败者左室舒张功能不全主要表现为E波下降时间（DTE）显著缩短（s：180．4±5．1比196．8±4．0，t=2．567，P=0．013），左室二尖瓣口舒张早期／晚期充盈速度比值（E／A）显著升高（1．47±0．08比1．14±0．05，t=3．827，P=0．000），侧壁部、间隔部及平均左室二尖瓣口舒张早期充盈速度／二尖瓣环舒张早期最大运动速度比值（E／Em）均显著升高（10．26±0．52比7．28±0．41，t=4．535，P=0．000；10．08±0．58比8．16±0．40，t=2．797，P=0．007
Objective To investigate the predictive value of left ventricular diastolic function on mechanical ventilation weaning in patients with left ventricular ejection fraction （LVEF） 〉 0.50. Methods A retrospective case control study was conducted. Sixty-five patients with LVEF 〉 0.50 undergoing mechanical ventilation for more than 48 hours admitted to surgery intensive care unit （ICU） of China-Japan Friendship Hospital from June 2014 to December 2016 were enrolled. The clinical data and parameters of eehocardiography before spontaneous breathing trial （SBT） were collected. The possible relationship between left ventricular diastolic function and the results of weaning was analyzed according to analysis of blood flow filling parameters of mitral valve orifice. According to the grading standard of left ventrieular diastolic function, the patients were divided into normal, mild （level 1） and moderate to severe （level 2-3） groups, and the outcomes of weaning were compared among the groups. Then patients were also divided into two groups of weaning successfully and weaning failure, and the clinical data and left ventricular diastolic function parameters of patients were compared between the two groups. The predictive value of left ventricular diastolic function on results of weaning was evaluated with receiver operating characteristic curve （ROC）. Results Sixty-five patients were enrolled and 28 patients （43.1%） failed weaning, 22 patients failed the first SBT and 6 required reintubation within 48 hours, 31 of the patients presented normal left ventricular diastolic function, 9 of patients presented mild diastolic dysfunction, and 25 of them presented moderate to severe diastolic dysfunction. So with the gradual increase of the severity of diastolic dysfunction, the rate of weaning failure was gradually increased, which was 16.1%, 44.6% and 76.0% respectively （ Х^2 = 20.240, P = 0.001）. Patients who failed weaning presented evidence of increased left ventricular filling pressures at pr
出处
《中华危重病急救医学》
CAS
CSCD
北大核心
2017年第5期413-418,共6页
Chinese Critical Care Medicine
基金
国家自然科学基金青年科学基金项目（81401629）
关键词
多普勒超声
左室舒张功能不全
自主呼吸试验
撤机
Doppler echocardiography
Left ventrieular diastolic dysfunction
Spontaneous breathing trial
Weaning
