摘要
目的探讨肺部超声B线评分(LUBS)联合膈肌超声对重症呼吸衰竭患儿机械通气撤机结局的预测价值。方法选择接受机械通气治疗的重症呼吸衰竭患儿110例,根据撤机结局分为撤机成功组83例、撤机失败组27例。两组均于自主呼吸试验30 min内行床旁肺部超声检查,计算LUBS;行膈肌超声检查,测量膈肌移动度,计算膈肌浅快呼吸指数(D-RSBI)和膈肌厚度变化率。分析LUBS和膈肌超声对重症呼吸衰竭患儿机械通气撤机结局的预测价值。结果撤机成功组呼吸频率、APACHEⅡ评分、LUBS、D-RSBI均低于撤机失败组,膈肌移动度、膈肌厚度变化率均高于撤机失败组(P均<0.05)。多因素Logistic回归分析显示,LUBS、APACHEⅡ评分、D-RSBI升高为重症呼吸衰竭患儿机械通气撤机失败的危险因素,而膈肌移动度、膈肌厚度变化率升高则为其保护因素(P均<0.05)。Pearson相关分析显示,重症呼吸衰竭患儿LUBS与膈肌移动度、膈肌厚度变化率均呈负相关关系(r分别为-0.375、-0.411,P均<0.05),与D-RSBI呈正相关关系(r=0.526,P<0.05)。受试者工作特征曲线分析显示,LUBS、膈肌移动度、膈肌厚度变化率、D-RSBI预测重症呼吸衰竭患儿机械通气撤机失败的曲线下面积分别为0.773、0.805、0.848、0.808,各指标联合预测重症呼吸衰竭患儿机械通气撤机失败的曲线下面积为0.943。结论LUBS和膈肌超声对重症呼吸衰竭患儿机械通气撤机结局均有一定预测价值,二者联合能够进一步提高其预测价值。
Objective To investigate the predictive value of lung ultrasound B-line score(LUBS)combined with diaphragm ultrasound in mechanical ventilation withdrawal outcome of severe respiratory failure children.Methods Totally 110 children with severe respiratory failure who received mechanical ventilation were divided into the successful group(83 cases)and failed group(27 cases).Both groups underwent bedside lung ultrasound examination within 30 minutes of the spontaneous breathing test,and LUBS was calculated.Diaphragmatic ultrasound was performed to measure diaphragmatic movement,and diaphragmatic rapid shallow breathing index(D-RSBI)and the change rate of diaphragmatic thickness were calculated.We analyze the predictive value of LUBS and diaphragm ultrasound in the outcome of mechanical ventila‑tion withdrawal in children with severe respiratory failure.Results The respiratory rate,APACHEⅡscore,LUBS and D-RSBI in the successful group were lower than those in the failed group,and the diaphragm mobility and diaphragm thick‑ness change rate were higher than those in the failed group(all P<0.05).Multivariate Logistic regression analysis showed that LUBS,APACHEⅡscore and D-RSBI were risk factors for withdrawal failure in children with severe respiratory fail‑ure,while diaphragm mobility and diaphragm thickness change rate were protective factors(all P<0.05).Pearson correla‑tion analysis showed that LUBS was negatively correlated with the degree of diaphragm movement and the change rate of diaphragm thickness in children with severe response failure(r=–0.375,–0.411,respectively;both P<0.05),but was positively correlated with D-RSBI(r=0.526,P<0.05).The receiver operating characteristic curve analysis showed that the area under the curve of LUBS,diaphragm mobility,diaphragm thickness change rate and D-RSBI in predicting with‑drawal failure of children with severe respiratory failure was 0.773,0.805,0.848 and 0.808,respectively,and the area under the curve of all indexes combined in predicting withdrawal fail
作者
王冰冰
林莉妃
陈寸
莫李媚
范会文
WANG Bingbing;LIN Lifei;CHEN Cun;MO Limei;FAN Huiwen(Department of Ultrasound,Hainan Hospital,Shanghai Children's Medical Center Affiliated to Shanghai Jiaotong University School of Medicine,Sanya 572000,China;不详)
出处
《山东医药》
CAS
2024年第25期35-39,共5页
Shandong Medical Journal
基金
海南省卫生健康行业科研项目(20A200366)。
关键词
重症呼吸衰竭
机械通气
肺部超声B线评分
膈肌超声
撤机结局
儿童
severe respiratory failure
mechanical ventilation
pulmonary ultrasound B line score
diaphragm ultrasound
withdrawal outcome
children
