查看更多>>摘要：目的 探讨膈肌浅快呼吸指数(D-RSBI)联合肺部超声评分(LUS)用于重症监护病房(ICU)患者机械通气后脱机不良结局的预测价值。 方法 本研究为病例对照研究。采用非随机抽样的方法选取2020年10月至2022年10月自贡市第四人民医院ICU收治的100例接受机械通气治疗的患者，根据脱机结果分为脱机成功组(63例)和脱机失败组(37例)。收集所有患者入院时性别、年龄、基础病(糖尿病、高血压、高脂血症、慢性阻塞性肺疾病)、心率、平均动脉压，以及机械通气时间、白细胞计数、乳酸和肌酐水平等临床资料，计算浅快呼吸指数(RSBI)和D-RSBI，并进行LUS。通过受试者操作特征曲线分析D-RSBI、RSBI、LUS预测脱机不良结局的价值，采用平行试验进行联合诊断，采用多因素logistic回归分析明确患者脱机不良结局的危险因素，并采用Spearman秩相关分析D-RSBI、LUS与RSBI的相关性。 结果 2组患者性别、年龄、心率、糖尿病、高血压、高脂血症、慢性阻塞性肺疾病、平均动脉压、机械通气时间、白细胞计数、肌酐和乳酸水平比较差异均无统计学意义(均P>0.05)，脱机失败组RSBI、D-RSBI、LUS高于脱机成功组[(56.63±11.18)次·min-1·L-1比(43.58±9.24)次·min-1·L-1，(1.86±0.62)次·min-1·mm-1比(1.13±0.36)次·min-1·mm-1，(38.63±7.51)分比(26.85±6.29)分；t值分别为6.30、7.46、8.41，均P<0.05]。RSBI、D-RSBI、LUS预测脱机不良结局的曲线下面积分别为0.807、0.863、0.831，D-RSBI联合LUS预测脱机不良结局的曲线下面积为0.946。多因素logistic回归分析结果显示，RSBI>53.489次·min-1·L-1、D-RSBI>1.429次·min-1·mm-1、LUS>32.683分是脱机失败的独立危险因素。D-RSBI与RSBI呈正相关(r＝0.335，P＝0.002)，LUS与RSBI无相关性(r＝0.184，P＝0.671)。 结论 D-RSBI联合LUS可用于预测ICU患者机械通气后脱机不良结局。D-RSBI>1.429次·min-1·mm-1、LUS>32.683分是脱机失败的独立危险因素。 Objective To explore the value of diaphragmatic rapid shallow breathing index (D-RSBI) combined with lung ultrasound score (LUS) for predicting adverse outcomes of weaning from mechanical ventilation in intensive care unit (ICU) patients. Methods It was a case-control study.One hundred patients who received mechanical ventilation treatment in the ICU of Zigong Fourth People′s Hospital from October 2020 to October 2022 were enrolled by the non-random sampling method.They were divided into successful weaning group (63 cases) and failed weaning group (37 cases) based on the weaning results.The age, gender, underlying diseases (diabetes, hypertension, hyperlipidemia, chronic obstructive pulmonary disease [COPD]), heart rate (HR), mean arterial pressure (MAP), mechanical ventilation time, white blood cell count (WBC), lactic acid and creatinine (Cr) on admission were collected.The rapid shallow breathing index (RSBI) and D-RSBI were calculated, and the lung ultrasound was performed to calculate the LUS score.The value of D-RSBI, RSBI and LUS in predicting adverse outcomes of weaning from mechanical ventilation in ICU patients was identified by plotting the receiver operator characteristic (ROC) curves.The combined diagnosis was performed for parallel tests.Multivariate logistic regression analysis was used to identify the risk factors for adverse outcomes of weaning from mechanical ventilation in ICU patients.Spearman rank correlation analysis was used to examine the correlation of RSBI with D-RSBI and LUS. Results There were no significant differences in gender, age, HR, diabetes, hypertension, hyperlipidemia, COPD, MAP, mechanical ventilation time, WBC, lactic acid and Cr levels between groups (all P>0.05).RSBI ([56.63±11.18] times·min-1·L-1 vs[43.58±9.24] times·min-1·L-1, t=6.30), D-RSBI ([1.86±0.62] times·min-1·mm-1 vs [1.13±0.36] times·min-1·mm-1, t=7.46) and LUS ([38.63±7.51] points vs [26.85±6.29] points, t=8.41) in the failed weaning group were significantly higher than those of the successful weaning group (all P<0.05).The area under the curve (AUC) of RSBI, D-RSBI and LUS for predicting adverse outcomes of weaning from mechanical ventilation in ICU patients was 0.807, 0.863 and 0.831, respectively, which of the combination of D-RSBI and LUS was 0.946.Multivariate Logistic regression analysis showed that RSBI>53.489 times·min-1·L-1, D-RSBI>1.429 times·min-1·mm-1 and LUS>32.683 points were independent risk factors for the failure of weaning from mechanical ventilation.D-RSBI was positively correlated with RSBI (r=0.335, P=0.002), while LUS was not correlated with RSBI (r=0.184, P=0.671). Conclusions D-RSBI combined with LUS can be used to predict the adverse outcomes of weaning from mechanical ventilation in ICU patients.D-RSBI>1.429 times·min-1·mm-1 and LUS>32.683 points are independent risk factors for the failure of weaning from mechanical ventilation.
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