摘要
目的 探讨床旁多脏器超声预测重症患者机械通气撤机风险的临床价值.方法 选取于我院重症监护室行机械通气的重症患者200例,其中撤机成功组127例,撤机失败组73例,均行床旁多脏器超声获取左室射血分数(LVEF)、膈肌增厚率(DTF)、膈肌移动度(DE)、肺超声评分(LUS),比较两组上述参数差异.采用多因素Logistic回归分析筛选预测重症患者机械通气撤机风险的独立影响因素;绘制受试者工作特征(ROC)曲线分析床旁多脏器超声预测重症患者机械通气撤机风险的诊断效能.结果 撤机失败组LVEF、DTF、DE均低于撤机成功组,LUS高于撤机成功组,差异均有统计学意义(均P＜0.05).多因素Logistic回归分析显示,LUS为预测重症患者机械通气撤机风险的独立危险因素(OR=2.008,P＜0.05),LVEF、DTF、DE均为独立保护因素(OR=0.764、0.811、0.760,均P＜0.05).ROC曲线分析显示,LUS、LVEF、DTF、DE及其联合应用预测重症患者机械通气撤机风险的曲线下面积分别为0.816、0.767、0.814、0.777、0.900,联合应用的曲线下面积高于各参数单独应用(Z=5.224、5.435、4.755、5.725,均P＜0.05).结论 床旁多脏器超声在预测重症患者机械通气撤机风险中具有一定的临床价值.
Abstract
Objective To explore the clinical value of bedside multi-organ ultrasound in predicting the risk of mechanical ventilation weaning in critically ill patients.Methods A total of 200 critically ill patients who were treated with mechanical ventilation in the intensive care unit from our hospital were enrolled,including 127 cases in the successful weaning group and 73 cases in the failed weaning group.All the patients were examined by bedside multi-organ ultrasound.The differences in left ventricular ejection fraction(LVEF),diaphragm thickening rate(DTF),diaphragm excursion(DE),and lung ultrasound score(LUS)were compared between the two groups.Multivariate Logistic regression was used to analyze the independent influencing factors for predicting the risk of mechanical ventilation weaning in critically ill patients.Receiver operating characteristic(ROC)curve was drawn to analyze the diagnostic efficacy of bedside multi-organ ultrasound in predicting the risk of mechanical ventilation weaning in critically ill patients.Results The LVEF,DTF,and DE in the failed weaning group were lower and LUS was higher than those in the successful weaning group(all P＜0.05).Multivariate Logistics regression analysis showed that LUS was the independent risk factor for predicting the risk of mechanical ventilation weaning(OR=2.008,P＜0.05),and LVEF,DTF and DE were independent protective factors(OR=0.764,0.811,0.760,all P＜0.05).ROC curve analysis showed that the area under the curve(AUC)of LUS,LVEF,DTF,DE and their combined application in predicting the risk of mechanical ventilation weaning failure in critically ill patients were 0.816,0.767,0.814,0.777 and 0.900,respectively.The AUC of the combined application was higher than that of each parameter used individually(Z=5.224,5.435,4.755,5.725,all P＜0.05).Conclusion Bedside multi-organ ultrasound has certain clinical value in predicting the risk of mechanical ventilation weaning in critically ill patients.
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