摘要
目的:探究超声评估膈肌增厚分数(DTF)对机械通气患者脱机结局的预测价值。方法:选取2021年8月~2022年4月芜湖市第二人民医院收治的55例机械通气患者,行自主呼吸试验(SBT),测量膈肌移动度(DE)、吸气/呼气末膈肌厚度(DTi/DTe),计算DTF,并搜集患者一般资料及临床特征资料,依据脱机结局将患者分为脱机成功组和脱机失败组,分析相关指标对脱机结局的影响及预测价值。结果:最终共50例患者纳入统计分析,脱机成功组和失败组患者分别为35例和15例。脱机成功组患者年龄低于脱机失败组患者(P<0.01),DE、DTi、DTF指标均高于脱机失败组患者(P<0.05)。多因素Logistic回归分析显示,DTF增高(OR=0.879)为脱机成功的保护因素(P<0.01),矫正年龄因素后仍为脱机成功的保护因素(OR=0.875,P<0.01)。DTF指标预测脱机结局的ROC曲线显示,其截点值为23.5%,AUC及95%CI为0.825(0.706~0.943)(P<0.001);灵敏度和特异度分别为77.1%和73.3%。结论:超声评估膈肌功能对机械通气患者脱机具有指导意义,其中DTF对脱机结局具有较大预测价值。
Objective:To assess the value of ultrasonic diaphragm thickening fraction(DTF)in predicting the outcome of patients weaning from mechanical ventilation.Methods:Fifty-five mechanically ventilated patients treated in our department were included from August 2021 to April 2022.All patients underwent spontaneous breathing test(SBT),measurement of diaphragm excursion(DE),diaphragm thickness at the end of inspiration/expiration(DTi/DTe)as well as DTF.The demographic information and clinical data were also collected.Then the patients were divided into the success group and the failure group according to the weaning outcome.The impact of relevant indicators on the weaning outcome and its predictive value were analyzed.Results:A total of 50 patients in this study were included in the final statistical analysis.The number of cases in the weaning success group and the failure group were 35 and 15 respectively.The age of patients in the successful group was lower than that in the failed group(P<0.01),and the indexes of DE,DTi and DTF were higher in the success group than in the failure group(P<0.05).Multivariate logistic analysis showed that increased DTF(OR=0.879)was a protective factor for successful weaning of the ventilator(P<0.01),even though after correction of age factor(OR=0.875,P<0.01).ROC curve of DTF index predicting weaning outcome showed that its cutoff value was 23.5%,AUC and 95%CI were 0.825(0.706-0.943)(P<0.001).The sensitivity and specificity were 77.1%and 73.3%,respectively.Conclusion:Ultrasound assessment of the diaphragm function has guiding significance to decide the timing of weaning from mechanical ventilation,and DTF possesses great predictive value for the outcomes of patients after weaning from the ventilator.
作者
潘友俊
吴克盛
解艳丽
钱言
江波
陈尚华
PAN Youjun;WU Kesheng;XIE Yanli;QIAN Yan;JIANG Bo;CHEN Shanghua(Department of Critical Care Medicine,Wuhu Hospital Affiliated to East China Normal University,Wuhu 241000,China)
出处
《皖南医学院学报》
CAS
2022年第6期561-564,共4页
Journal of Wannan Medical College
基金
芜湖市卫生和计划生育委员会科研课题(WHWJ2021y023)。
关键词
超声
自主呼吸试验
膈肌移动度
膈肌增厚分数
ultrasound
spontaneous breathing test
diaphragm excursion
diaphragm thickening fraction
