摘要
目的 评估膈肌超声新指标对机械通气患者撤机结果的预测价值.方法 纳入2016年12月至2017年12月河北省人民医院重症监护病房行机械通气>48 h且准备撤机的患者.自主呼吸试验期间使用床旁超声测量并计算患者膈肌移动度(D E)、膈肌浅快呼吸指数(D-RSBI),并同时记录浅快呼吸指数及其他生理指标.采用受试者工作特征(ROC)曲线评价DE和D-RSBI对撤机成败的预测价值.结果 本研究共纳入54例患者,其中撤机成功36例,撤机失败18例,成功组患者DE明显高于失败组,但浅快呼吸指数及D-RBSI明显低于失败组(P值均=0.001).DE取10.8 mm为cut-off值,预测撤机ROC曲线下面积为0.778,敏感度和特异度分别为83.3% 和83.3%;D-RBSI取2.03次·min-1·mm-1为cut-off值,预测撤机ROC曲线下面积为0.810,敏感度和特异度分别为77.8% 和72.2%.结论 膈肌超声新指标DE、D-RSBI对预测撤机结果有较强的实用价值.
Objective To evaluate the predictive value of diaphragmatic ultrasound for the outcomes of ventilator weaning in patients with mechanical ventilation . Methods Patients were ventilated mechanically for more than 48 hours and ready to be weaned when they admitted to ICU of Hebei General Hospital from December 2016 to December 2017 were enrolled .During the T-tube spontaneous breathing trial ,the diaphragmatic excursion ( DE) and diaphragmatic rapid shallow breathing index ( D-RSBI) were measured and calculated by bedside ultrasound .Rapid shallow breathing index and other physiological fingers were recorded . Receiver operator characteristic ( ROC) curve was used to evaluate the predictive value of DE and D-RSBI for weaning .Results A total of 54 patients were enrolled in this study .Among them ,36 were successful in weaning and 18 failed in weaning .DE in successful group was significantly higher than that in failure group ,but rapid shallow breathing index and D-RSBI were significantly lower than those in failure group ( both P =0 .001) .When the cut-off value of DE was 1.08 mm ,the areas under the ROC curve for DE was 0 .778 ,sensitivity and specificity were 83.3% and 83.3% respectively .When the cut-off value of D-RSBI was 2.03 breaths· min^-1 · mm^-1 ,area under the curve for D-RSBI was 0.810 ,sensitivity and specificity were 77.8% and 72.2% respectively .Conclusions DE and D-RSBI measured by diaphragmatic ultrasound are useful for predicting outcomes of weaning .
作者
龙玲
赵浩天
何聪
任珊
赵鹤龄
Long Ling;Zhao Haotian;He Cong;Ren Shan;Zhao Heling(Department of Critical Care Medicine, Hebei General Hospital, Shijiazhuang 050017,China;Department of Ultrasound, Hebei General Hospital, Shijiazhuang 050017, China)
出处
《国际呼吸杂志》
2019年第14期1073-1077,共5页
International Journal of Respiration
关键词
膈肌超声
撤机
膈肌移动度
膈肌浅快呼吸指数
Diaphragmatic ultrasound
Weaning
Diaphragmatic extraction
Diaphragmatic rapid shallow breathing index
