膈肌超声对重症患者机械通气撤机的预测价值
Predictive value of diaphragmatic ultrasound in weaning of mechanical ventilation of critical ill patients

赵浩天等.膈肌超声对重症患者机械通气撤机的预测价值[J].内科急危重症杂志,2020,26(3):199-202

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DOI：10.11768/nkjwzzzz20200306

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基金项目:河北省科技计划项目（No:152777137）；河北省医学科学研究重点课题计划（No:20160083）；河北省政府资助临床医学优秀人才培养和基础课题研究项目（No:361003）

作者	单位	E-mail
赵浩天等	河北省人民医等	：zhheling@sina.com

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中文摘要:

目的：评价膈肌超声对机械通气（MV）患者撤机结果的预测价值。方法：选取行MV时间＞48h的重症患者41例，在符合撤机条件后使用T管进行自主呼吸试验（SBT），于SBT30min时使用床旁超声测量患者右侧躯体的膈肌移动度（DE）和膈肌厚度，并计算膈肌增厚率（DTF），根据撤机成败与否将患者分为撤机成功组（26例）和撤机失败组（15例）。采用受试者工作特征（ROC）曲线〖JP2〗评价膈肌功能超声指标对撤机的指导价值。结果：撤机成功组患者DE及DTF高于撤机失败组（均P＜0.05）。分别选取1.08cm和30%作为DE和DTF的截断值，其预测撤机成功的敏感度分别为80.77%和65.38%，特异度分别为80.00%和60.00%，ROC曲线下面积分别为0.751（95%CI：0.571~0.932）和0.668（95%CI：0.484~0.852）。结论：膈肌功能超声监测可作为重症医学科MV患者撤机能力的预测指标，对撤机具有较好的指导价值。

英文摘要:

Objective: To evaluate the predictive value of diaphragmatic ultrasound in guiding the outcome in weaning of mechanical ventilation (MV) patients. Methods: Forty one critical ill patients received MV over 48h enrolled in this study. The T piece was used for spontaneous breathing test (SBT) when meeting the criteria of weaning. At the 30 min of SBT, the diaphragm excursion (DE) and the diaphragm thickening fraction (DTF) of right hemi diaphragm were measured by ultrasound. These patients were divided into success weaning group (26 cases) and failure weaning group (15 cases) according to the results of the weaning. The receiver operating characteristic (ROC) curve was used to evaluate the guidance value of the diaphragmatic ultrasound index in weaning of the mechanical ventilation. Results: The DE and DTF in the successful weaning group were significantly increased as compared with those in the failure weaning group (all P <0.05). Using 1.08 cm and 30% as the cut off values of DE and DTF respectively, the sensitivity of predicting the success of weaning was80.77% and 65.38%, the specificity was 80.00% and 60.00%, and the area under the ROC curve was 0.751 (95% CI: 0.571 0.932) and 0.668 (95% CI : 0.484 0.852), respectively. Conclusion: Ultrasonic monitoring of diaphragm function can be used as a predictor of MV weaning capacity in the department of intensive care unit, which has a better predictive value for weaning.