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中国临床研究:2023,36(8):1223-1227
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超声评估膈肌功能联合超声心动图预测机械通气患者撤机的价值
(1. 南通大学附属医院超声科,江苏 南通 226001;2. 南通大学医学院,江苏 南通 226001;3. 南京江北医院功能科,江苏 南京 210008)
Value of ultrasound assessment of diaphragm function combined with echocardiography in predicting weaning in mechanically ventilated patients
摘要
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投稿时间:2022-12-09   网络发布日期:2023-08-20
中文摘要: 目的探讨使用超声评估膈肌功能,及其联合超声心动图预测机械通气患者撤机结局的价值。方法选择2021年11月至2022年9月在南京江北医院ICU使用呼吸机治疗准备拔管的患者37例,满足撤机条件后,在自主呼吸试验时使用M超测量膈肌位移(DE),组织多普勒测量膈肌收缩速度,使用超声心动图测量心脏收缩、舒张功能指标左室射血分数(EF)和E/e′。根据脱机结果将受试者分为成功组和失败组,分析各指标与撤机结局的相关性,并绘制ROC曲线探讨其预测价值。结果37例患者中有3例脱组,成功入组的34例患者中成功撤机24例(成功组),失败10例(失败组)。两组的膈肌收缩速度和EF差异无统计学意义(P>0.05)。成功组DE高于失败组,E/e′低于失败组,差异有统计学意义(P<0.05)。DE的ROC曲线的AUC为0.808,敏感度为70.8%,特异度为90.0%。E/e′ROC曲线的AUC为0.896,敏感度为70.8%,特异度为100%。E/e'预测价值高于DE。将DE、E/e′联合,ROC曲线的AUC为0.958,其敏感度为83.0%,特异度为100%。结论DE和E/e′对撤机结局有预测价值。将二者联合可提高预测敏感度和特异度,比单一指标预测能力更强。
Abstract:ObjectiveTo evaluate the predictive value of diaphragmatic ultrasound with echocardiography in weaning from mechanical ventilation. MethodsThirty-seven mechanical ventilated patients were enrolled in Nanjing Jiangbei Hospital from November 2021 to September 2022. When meeting the standard of weaning from mechanical ventilation, during spontaneous breathing test (SBT), diaphragmatic excursion (DE) was measured by anatomical M-mode ultrasound. Diaphragm contraction velocity were measured by tissue doppler, and cardiac function(EF and E/e′) were measured by echocardiography. The patients were divided into success group and failure group. The correlation between indicators and withdrawal outcomes was analyzed and the predictive value was explored by ROC curves. ResultsOf 37 patients, 3 were removed from the group, while out of 34 successfully enrolled patients, 24 were successfully removed from the machine (success group) and 10 were unsuccessful (failure group). The differences in diaphragm contraction speed and EF between the two groups were not statistically significant (P>0.05), while the differences in DE and E/e′ were statistically significant (P<0.05). The AUC, sensitivity, 〖JP2〗and specificity was 0.808, 70.8% and 90.0% of DE, was 0.896, 70.8% and 100% of E/e′, was 0.958, 83.0% and 100% of DE combined with E/e′. ConclusionDE and E/e′can be used in predicting the ending in mechanical ventilation withdrawal. Combining the two can improve prediction sensitivity and specificity, which is stronger than single indicator prediction ability.
文章编号:     中图分类号:R445.1    文献标志码:B
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引用文本:
左凌宇,陈晓阳.超声评估膈肌功能联合超声心动图预测机械通气患者撤机的价值[J].中国临床研究,2023,36(8):1223-1227.

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