摘要
目的探究超声膈肌增厚分数(diaphragmatic thickening fraction,DTF)联合峰压(peak pressure,PP)和驱动压(driving pressure,DP)对脓毒症机械通气患者撤机预测价值。方法回顾性分析2018年2月-2020年8月南通大学第五附属医院(泰州市人民医院)收治的116例脓毒症机械通气患者的临床资料。依据机械通气是否撤机成功,并分为失败组和成功组;对比失败组和成功组DTF、PP及DP水平;Logistic回归分析探讨影响脓毒症机械通气患者撤机失败的相关因素。制作受试者工作特征曲(receiver operating characteristic curve,ROC),分析DTF联合PP及DP对脓毒症机械通气患者撤机预测价值。结果本研究脓毒症机械通气患者撤机失败发生率为29.31%(34/116);失败组脓毒症休克占比、机械通气时间、序贯器官衰竭估计(sequential organ failure assess⁃ment,SOFA)评分、呼吸频率(RR)、浅快呼吸指数(rapid shallow breath index,RSBI)、吸入氧体积分数(inhaled oxy⁃gen volume fraction,FiO_(2))、左心房内径(left atrium diameter,LAD)、PP及DP均显著高于成功组(P<0.05);失败组动脉血氧分压(arterial partial pressure of oxygen,PaO_(2))、氧合指数(PaO_(2)/FiO_(2))、左室射血分数(left ventricular ejec⁃tion fraction,LVEF)、膈肌移动度(diaphragm mobility,DE)及超声DTF则均显著低于成功组(P<0.05);Logistic回归分析显示,脓毒症分级、机械通气时间、超声DTF、PP及DP均为脓毒症机械通气患者撤机失败的影响因素(OR=4.166、2.959、3.043、3.501、3.865);ROC分析显示,超声DTF、PP及DP预测脓毒症机械通气患者撤机失败的最佳截断点分别为26.87%、16.75 cmH_(2)0、7.53 cmH_(2)0,三者联合的特异度为95.12%,高于超声DTF、PP及DP单独进行评估的特异度,且超声DTF、PP及DP三者联合预测脓毒症机械通气患者撤机失败的曲线下面积(area under curve,AUC)为0.878,显著高于超声DTF、PP、DP水平单独预测的AUC(P<0.05)。结论超声DTF、PP及DP联合对�
Objective To explore the predictive value of ultrasound diaphragm thickening fraction(DTF)combined with peak pressure(PP)and driving pressure(DP)in weaning patients with sepsis on mechanical ventilation.Methods A retrospective analysis of the clinical data of 116 cases of sepsis mechanically ventilated patients admitted to the Fifth Affiliated Hospital of Nantong University(Taizhou People's Hospital)from February 2018 to August 2020.According to whether the mechanical ventilation is weaned successfully,it is divided into failure group and success group.Compare the DTF,PP and DP levels of the failure group and the success group.Logistic regression analysis to explore the related factors that affect the failure of weaning in sepsis patients with mechanical ventilation.Produce receiver operating characteristic curve(ROC),analyze the predictive value of DTF combined with PP and DP for weaning patients with sepsis on mechanical ventilation.Results In this study,the incidence of weaning failure in mechanically ventilated patients with sepsis was 29.31%(34/116).The proportion of septic shock in the failure group,mechanical ventilation time,sequential organ failure estimation(SOFA)score,respiratory rate(RR),rapid shallow breathing index(RSBI),volume fraction of inspired oxygen(FiO_(2)),left atrial diameter(LAD)),PP and DP were significantly higher than the success group(P<0.05).Arterial partial pressure of oxygen(PaO_(2)),oxygenation index(PaO_(2)/FiO_(2)),left ventricular ejection fraction(LVEF),diaphragm mobility(DE)and ultrasound DTF in the failure group were significantly lower than those in the success group(P<0.05).Logistic regression analysis showed that sepsis grade,mechanical ventilation time,ultrasound DTF,PP and DP are all influencing factors of weaning failure in patients with sepsis and mechanical ventilation(OR=4.166,2.959,3.043,3.501,3.865).ROC analysis showed that the best cut-off points of ultrasound DTF,PP,and DP for predicting weaning failure in sepsis mechanically ventilated patients were 26.87%,16.75
作者
薛寒
陈小枫
缪小莉
揭红英
吴银凤
XUE Han;CHEN Xiaofeng;MIAO Xiaoli;JIE Hongying;WU Yinfen(Taizhou People's Hospital,Taizhou Jiangsu 225300,China)
出处
《中国急救复苏与灾害医学杂志》
2021年第10期1146-1149,1153,共5页
China Journal of Emergency Resuscitation and Disaster Medicine
基金
江苏省卫生计生委医学科研课题(编号:H201658)。
关键词
超声膈肌增厚分数
峰压
驱动压
脓毒症
机械通气
撤机
Diaphragm thickening fraction(DTF)
Peak pressure(PP)
Driving pressure(DP)
Sepsis
Mechanical ventilation
Weaning
