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投稿时间：2024-05-20 网络发布日期：2025-03-20
投稿时间：2024-05-20 网络发布日期：2025-03-20
中文摘要: 目的 探讨术前超声监测膈肌变化对不同氧分压患者胸腔镜术中低氧血症发生的预测价值。方法 将2023年1月至2024年3月江宁医院拟行胸腔镜肺部分切除患者159例，根据术前氧分压的结果分为A组（60 mmHg≤氧分压≤75 mmHg）和B组（氧分压＞75 mmHg）。对两组膈肌超声的参数（平静呼吸膈肌移动度、用力呼吸膈肌移动度、平静呼吸膈肌厚度变化率、用力呼吸膈肌厚度变化率）进行比较。根据术中血氧饱和度情况，观察是否发生低氧血症。构建受试者工作特征（ROC）曲线分析膈肌超声参数对术中低氧血症发生的预测价值。结果 A组低氧血症发生率高于B组（35.7% vs 13.0%,χ2=6.920,P＜0.01）。与B组比较，A组的膈肌移动幅度更低，吸气末膈肌厚度更薄，膈肌增厚率更低，差异均有统计学意义（P＜0.01）；呼气末的膈肌厚度两组之间差异无统计学意义（P＞0.05）。平静呼吸膈肌移动度和平静呼吸膈肌增厚率与氧分压呈正相关（r=0.186、0.212，P＜0.05），用力呼吸膈肌移动度和用力呼吸膈肌增厚率与氧分压呈正相关（r=0.306、0.403, P＜0.01）。ROC曲线分析发现，用力呼吸膈肌移动度对应的最佳截断点3.52 cm，敏感度77.6%，特异度79.4%；用力呼吸膈肌增厚率对应的最佳截断点47.47%，敏感度85.6%，特异度82.4%。结论 膈肌超声对术前不同氧分压患者胸腔镜手术术中低氧血症有一定的预测价值。
Abstract:Objective To explore the predictive value of preoperative ultrasonographic monitoring of diaphragmatic changes in patients with different partial pressures of oxygen (PaO2) for hypoxemia during thoracoscopic surgery.MethodsA total of 159 patients scheduled for thoracoscopic lung resection at Jiangning Hospital from January 2023 to March 2024 were divided into group A (60 mmHg≤PaO2≤75 mmHg) and group B (PaO2＞75 mmHg) based on preoperative PaO2 results. Ultrasonographic parameters of the diaphragm (diaphragmatic excursion during quiet breathing, diaphragmatic excursion during forced breathing, diaphragmatic thickness change rate during quiet breathing, and diaphragmatic thickness change rate during forced breathing) were compared between the two groups. Based on intraoperative blood oxygen saturation levels, the occurrence of hypoxemia was observed. Receiver operating characteristic (ROC) curves were constructed to analyze the predictive value of diaphragmatic ultrasound parameters for intraoperative hypoxemia. ResultsThe incidence of hypoxemia in group A was higher then that in group B (35.7% vs 13.0%, χ2=26.920, P＜0.01). Compared with group B, group A had lower diaphragmatic excursion, thinner end-inspiratory diaphragmatic thickness, and lower diaphragmatic thickening rate, with statistically significant differences (P＜0.01); there was no significant difference in end-expiratory diaphragmatic thickness between the two groups (P＞0.05). Quiet breathing diaphragmatic excursion and thickening rate were positively correlated with PaO2 (r=0.186, 0.212, P＜0.05), while forced breathing diaphragmatic excursion and thickening rate were also positively correlated with PaO2 (r=0.306, 0.403, P＜0.01). The ROC curve analysis found that the optimal cutpoint for forced breathing diaphragmatic excursion was 3.52 cm, with a sensitivity of 77.6% and specificity of 79.4%; the optimal cutpoint for forced breathing diaphragmatic thickening rate was 47.47%, with a sensitivity of 85.6% and specificity of 82.4%. ConclusionDiaphragmatic ultrasound has certain predictive value for intraoperative hypoxemia during thoracoscopic surgery in patients with different preoperative PaO2 levels.
keywords: Partial pressure of oxygen Hypoxemia Parameters, diaphragmatic ultrasound Thoracoscopic surgery
文章编号： 中图分类号：R614.2 文献标志码：A
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附件
| 作者 | 单位 |
| 赵海波 | 1. 南京医科大学附属江宁医院麻醉科，江苏 南京 210000； |
| 沈华 | 2. 南京医科大学附属逸夫医院肿瘤科，江苏 南京 210000 |
| 尹宁 | 3. 南京医科大学附属逸夫医院麻醉科，江苏 南京 210000 |
| Author Name | Affiliation |
| ZHAO Haibo*, SHEN Hua, YIN Ning | *Department of Anesthesiology, Jiangning Hospital Affiliated to Nanjing Medical University, Nanjing,Jiangsu 210000, China |
引用文本：
赵海波,沈华,尹宁.膈肌超声对术前不同氧分压患者胸腔镜手术术中低氧血症的预测[J].中国临床研究,2025,38(3):441-444.
赵海波,沈华,尹宁.膈肌超声对术前不同氧分压患者胸腔镜手术术中低氧血症的预测[J].中国临床研究,2025,38(3):441-444.