摘要
目的探讨肺部超声联合膈肌超声对颈髓损伤机械通气患者撤机成功率的效果评价。方法回顾性分析2018年1月至2019年12月我院重症监护病房收治的高位颈髓损伤机械通气患者,机械通气时间>48 h,符合自主呼吸试验撤机(SBT)标准。所有患者均采用床边肺部B超和膈肌超声进行评估,测量计算膈肌的移动度(DD),膈肌浅快呼吸指数(D-RSBI)及肺部B线积分(LUBS)。根据撤机的结果将患者分为成功组及失败组,采用受试者工作特征曲线(ROC)评估分析各项指标的预测价值。结果撤机成功组45例,失败组15例。两组患者人群特征比较,差异无统计学意义(P>0.05)。撤机成功组为(8.91±0.92)分,撤机失败组为(13.52±1.21)分,两组比较,差异有统计意义(P=0.001);撤机成功组DD为(13.56±2.04)mm,失败组为(9.36±1.12) mm,差异有统计学意义(P=0.002)。撤机成功组D-RSBI明显低于撤机失败组,差异有统计学意义[(1.42±0.26)次/(min·mm) vs.(2.16±0.38)次/(min·mm),P=0.008]。D-RSBI、LUBS及联合对撤机失败均有预测效能。LUBS联合D-RSBI的预测效能最大,AUC值为0.982。结论肺膈联合超声能够很好的预测颈髓损伤机械通气患者脱管的结局,其中以LUBS联合D-RSBI的预测效能最大。
Objective To explore the success rate of weaning outcome of diaphragm and lung combined ultrasound in patients with mechanical ventilation for cervical spinal cord injury.Methods Patients with mechanical ventilation for upper cervical spinal cord injury treated in the intensive care unit of our hospital from January 2018 to December 2019 were enrolled in the retrospective analysis.The duration of mechanical ventilation was more than 48 hours,which met the weaning criteria of spontaneous breathing test(SBT).All patients were evaluated by bedside lung B-ultrasound and diaphragm ultrasound.The diaphragmatic displacement(DD),the diaphragmatic rapid shallow breathing index(D-RSBI),and the lung ultrasonic B-line score(LUBS)were measured.The patients were divided into the success group and the failure group according to the weaning outcome.The receiver operating characteristic curve(ROC)was adopted to evaluate and analyze the predictive value of each index.Results There were 45 patients in the success group and 15 patients in the failure group.There was no significant difference in the population characteristics between the two groups(P>0.05).The LUBS in the success group was(8.91±0.92)points,and in the failure group was(13.52±1.21)points,with statistically significant difference(P=0.001).The DD in the success group was(13.56±2.04)mm,and in the failure group was(9.36±1.12)mm,with statistically significant difference(P=0.002).The D-RSBI in the success group was significantly lower than that in the failure group,with statistically significant difference[(1.42±0.26)Times/(min·mm)vs.(2.16±0.38)Times/(min·mm),P=0.008].The D-RSBI,the LUBS,and the D-RSBI combined with LUBS all had predictive efficiency to failure of weaning.The predictive efficiency of D-RSBI combined with LUBS was highest,with AUC of 0.982.Conclusion Diaphragm and lung combined ultrasound can well predict the weaning outcome in patients with mechanical ventilation for cervical spinal cord injury,with the highest predictive efficiency of D-RSBI combine
作者
钟莉
唐坎凯
徐巍
李海东
ZHONG Li;TANG Kankai;XU Wei;LI Haidong(Department of Intensive Care Unit,the First People′s Hospital of Huzhou in Zhejiang Province,Huzhou 313000,China)
出处
《中国现代医生》
2021年第18期104-108,共5页
China Modern Doctor
基金
浙江省医药卫生科技计划项目(2021KY349)
浙江省湖州市科学技术局公益性应用研究项目(2020GYB22)。
关键词
膈肺联合超声
颈髓损伤
机械通气
撤机结局
Diaphragm and lung combined ultrasound
Cervical spinal cord injury
Mechanical ventilation
Weaning outcome
