| 摘要: |
| 目的比较膈肌超声相关指标膈肌动度浅快呼吸指数（DD-RSBI）、膈肌增厚浅快呼吸指数（DT-RSBI）与传统浅快呼吸指数（RSBI）在机械通气患者中预测撤机结果的价值。方法选取浙江省6家医院重症医学科连续收治的机械通气时间＞48h并行撤机自主呼吸试验（SBT）的患者131例。SBT过程中使用超声测量并计算膈肌移动度（DD）与膈肌增厚率（DTF），代替传统RSBI中的潮气量计算出新的DD-RSBI和DT-RSBI。根据撤机结果将患者分为撤机成功组与失败组，分析两组患者各指标间的差异。采用ROC曲线比较各指标预测撤机结果的价值。结果撤机成功组患者97例，撤机失败组患者34例。撤机失败组患者的RSBI、DD-RSBI及DT-RSBI均高于撤机成功组（均P＜0.05）。RSBI、DD-RSBI及DT-RSBI预测撤机失败的AUC分别为0.796（95%CI：0.712~0.903）、0.865（95%CI：0.798~0.931）、0.872（95%CI：0.801~0.942），以46.3次/（ml·min）、1.65次/（min·mm）、66次/min为阈值，其预测撤机失败的灵敏度分别为85.3%、73.5%、88.2%，特异度分别为56.7%、88.7%、59.8%。多因素logistic回归分析表明，高DD-RSBI（OR=5.46，95%CI：1.54～19.37）、高DT-RSBI（OR=1.06，95%CI：1.02～1.1）是撤机失败的独立危险因素（均P＜0.05）。结论膈肌超声指标DD-RSBI、DT-RSBI较传统RSBI预测撤机结果更准确，是指导撤机时机的较好指标。 |
| 关键词: 浅快呼吸指数 超声 膈肌 机械通气 撤机 |
| DOI：10.12056/j.issn.1006-2785.2018.40.9.2018-41 |
| 分类号: |
| 基金项目:国家卫生计生委科学研究基金-浙江省医药卫生重大科技计划项目(WKJ-ZJ-1601)；浙江省医药卫生科技计划项目（2017KY182、2018252194） |
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| Diaphragmatic ultrasonography in predicting outcome of ventilator weaning in patients with mechanical ventilation |
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the Second Clinical Medical College，Zhejiang Chinese Medical University
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| Abstract: |
| Objective To assess the value of indexes of diaphragmatic ultrasonography in predicting the outcomes of ventilator weaning in patients with mechanical ventilation. Methods One hundred and thirty one ICU patients from six hospitals in Zhejiang province, who underwent mechanical ventilation for ＞48h and were ready for spontaneous breathing test (SBT) from December 2016 to March 2017, were enrolled in the study. During the SBT, the diaphragmatic displacement and the diaphragm thickening fraction were measured with bedside ultrasonography, and the conventional rapid shallow breathing index (RSBT), diaphragmatic displacement rapid shallow breathing index (DD-RSBI) and diaphragm thickening rapid shallow breathing index
(DT-RSBI) were calculated. At the same time, other indicators related to weaning were also recorded. According to the weaning outcome, the patients were classified into a success group or a failure group. The differences of each index were analyzed between the two groups, and the receiver operator characteristic(ROC) curves were used to assess the value of each indicator in predicting weaning failure for ICU patients with mechanical ventilation. Results Among 131 patients, there were 34 patients (26%) failing the weaning attempt. The RSBI, DD-RSBI and DT-RSBI in success group were higher than those in failure group
and the differences were statistically significant (P ＜0.05). The area under the ROC curves (AUC) of RSBI, DD-RSBI and
DT-RSBI for predicting weaning failure was 0.796 (95% CI: 0.712~0.903), 0.86 (95% CI: 0.798~0.931) and 0.872 (95% CI: 0.801~0.942), respectively. Using 46.3 breaths/ (ml·min), 1.65 breaths/ (min·mm), 66 breaths/min as the threshold of RSBI, DD-RSBI and DT-RSBT, the sensitivity was 85.3% , 73.5% and 88.2% and the specificity was 56.7% , 88.7% and 59.8%, respectively. The multivariate logistic analysis showed that DD-RSBI （OR=5.46, 95% CI :1.54 ～19.37, P ＜0.05）and DT-RSBI (OR=1.06, 95%CI :1.02～1.1, P＜0.05) were independently associated with weaning failure. Conclusion DD-RSBI and DT-RSBI are more accurate than traditional RSBI in predicting weaning outcome and may be the better indicators to guide weaning for ICU patients with mechanical ventilation. |
| Key words: Rapidshallow breathing index Ultrasonography Diaphragm Mechanical ventilation Weaning |
