摘要
目的通过应用膈肌浅快呼吸指数(D-RSBI)是否可以预测撤机成功。方法采用前瞻性观察研究,在自主呼吸试验结束时记录患者呼吸频率(RR)和潮气量(VT),并应用M超声测量评估右侧膈肌移位(DD),记录撤机的结果、机械通气时间,重症加强治疗病房(ICU)住院时间和ICU死亡率。依据撤机结果,分为撤机成功组和撤机失败组,采用受试者工作特征(ROC)曲线分析快速浅呼吸指数(RSBI,RR/VT)及D-RSBI(RR/DD)对撤机失败预测的准确性。结果纳入110例患者,其中撤机成功组为73例(66.4%),撤机失败组为37例(33.6%),撤机失败组患者的RSBI、D-RSBI均高于撤机成功组(P<0.01)。RSBI、D-RSBI预测撤机失败的ROC曲线下面积分别为0.78(95%可信区间0.69-0.87)、0.91(95%可信区间0.85-0.97),分别以69次/(L·min)、1.5次/(min·mm)为临界值,其预测撤机失败的灵敏度分别为55%、87%,特异度分别为89%、80%。结论D-RSBI比传统指标RSBI预测撤机失败更准确。
Objective To evaluate the predictive value of diaphragmatic rapid shallow breathing index(D-RSBI) for weaning outcome prediction. Methods This was a prospective observation study. Respiratory rate(RR) and tidal volume(Vt) were recorded at the end of spontaneous breathing trial, and both M-Mode and B-Mode ultrasonography were used to assess the right diaphragmatic displacement(DD). In parallel, outcome of the weaning attempt, length of mechanical ventilation, length of stay in intensive care unit(ICU) and mortality of ICU were recorded. According to the weaning outcome, the patients were grouped into the successful group and the failed group. The receiver operator characteristic(ROC) curve was used to assess the value of rapid shallow breathing index(RSBI, RR/Vt) and D-RSBI(RR/DD) in predicting weaning failure for ICU patients with mechanical ventilation. Results A total of 110 patients recruited in this study. Of them, 73(66.4%) patients were successfully liberated from mechanical ventilation, and 37 patients failed(33.6%) weaning procedure. The RSBI and D-RSBI of the patients in the failed group were higher than those in the success weaning group(P<0.01). The area under the ROC curves of RSBI and D-RSBI for predicting weaning failure was 0.78(95% confidence interval 0.69-0.87), 0.91(95% confidence interval 0.85-0.97), respectively, a cutoff of RSBI>69 breaths/(L·min) yielded sensitivity of 55% and specificity of 89%, and a cutoff of D-RSBI>1.5 breaths/(min·mm)yielded sensitivity of 87% and specificity of 80%. Conclusion D-RSBI is more accurate than traditional RSBI in predicting the weaning outcome.
作者
赵永华
靳立振
于巧青
孟伟
刘东海
晁怀宇
ZHAO Yonghua;JIN Lizhen;YU Qiaoqing;MENG Wei;LIU Donghai;CHAO Huaiyu(Department of Critical Care Medicine,Langfang People's Hospital,Langfang,Hebei 065000,P.R.China;Department of Radiological diagnosis,Langfang People's Hospital,Langfang,Hebei 065000,P.R.China)
出处
《中国呼吸与危重监护杂志》
CAS
CSCD
北大核心
2021年第2期118-122,共5页
Chinese Journal of Respiratory and Critical Care Medicine
基金
廊坊市科技支撑计划项目(2017013083)。
关键词
浅快呼吸指数
机械通气
撤机
膈肌移动度
Rapid shallow breathing index
Mechanical ventilation
Weaning
Diaphragmatic displacement
