目的 研究肺部超声B线评分联合膈肌功能相关参数对重症机械通气患者撤机成功的预测价值.方法 选取2021年4月至2023年8月我院收治的重症机械通气患者115例,针对符合撤机条件患者行肺超声检查计算B线评分,并用T管行自主呼吸实验(spontaneous breathing trial,SBT),SBT 30 min时通过床旁超声获取右侧膈肌移动度、膈肌厚度,计算呼吸浅快指数、膈肌呼吸浅快指数、膈肌厚度变化率.以患者撤机后48 h呼吸状况分为撤机成功组78例和撤机失败组37例,收集患者临床资料.通过多元logistic回归分析影响撤机成功的相关因素,并通过受试者工作特征曲线(receiver operating characteristic,ROC)评估肺部超声B线评分联合膈肌功能相关参数对撤机的预测价值.结果 撤机失败组肺部超声B线评分、膈肌呼吸浅快指数大于撤机成功组,右侧膈肌移动度、膈肌厚度变化率小于撤机成功组(P＜0.05).撤机失败组急性生理学与慢性健康状况评分系统Ⅱ(Acute Physiology and Chronic Health Evaluation,APACHE-Ⅱ)评分、序贯器官衰竭评分(Sequen-tial Organ Failure Assessment,SOFA)、呼吸频率、呼吸浅快指数高于撤机成功组,机械通气时间少于撤机成功组(P＜0.05).经logistic回归结果得出,肺部超声B线评分、膈肌呼吸浅快指数、右侧膈肌移动度、膈肌厚度变化率、APACHE-Ⅱ评分、SOFA评分、呼吸频率、呼吸浅快指数是撤机成功重要影响因素(P＜0.05).经ROC曲线分析得出,肺部超声B线评分、膈肌呼吸浅快指数、右侧膈肌移动度、膈肌厚度变化率联合预测曲线下面积(area under curve,AUC)为0.931,优于单一预测结果(P＜0.05).结论 肺部超声B线评分联合膈肌功能相关参数对重症机械通气患者撤机成功的预测价值较高.
The Predictive Value of Lung Ultrasound B-line Score Combined with Diaphragm Function-Related Parameters for Weaning from Severe Mechanical Ventilation Patients
Objective To explore the predictive value of lung ultrasound B-line score combined with diaphragm function-related parameters for weaning from severe mechanical ventilation patients.Methods A total of one hundred and fifteen critically ill mechanically ventilated patients admitted to our hospital from April 2021 to August 2023 were selected.Patients'readiness for weaning was assessed through lung ultrasonography with a calculated B-line score,and spontaneous breathing trials(SBT)with a T-tube pres-sure support.The indicators of right diaphragmatic excursion and thickness were determined by bedside ultrasound at 30 min of SBT.The diaphragm rapid shallow breathing index,diaphragmatic excursion,and thickness were recorded.Patients were divided into the success group(n=78)and the failure group(n=37)based on their respiratory status 48 hours after weaning.The clinical data were collected,multivariate Logistic regression was used to identify factors affecting the successful weaning in critically ill mechanically ven-tilated patients,and receiver operating characteristic curve(ROC)was plotted to evaluate the predictive value of lung ultrasound B-line score combined with diaphragm function-related parameters for weaning in critically ill mechanically ventilated patients.Results The failure group reported a larger B-line score and diaphragm rapid shallow breathing index,and a smaller changes in diaphragmatic excursion and thickness compared to the success group(P＜0.05).The Acute Physiology and Chronic Health Evaluation Ⅱ(APACHE-Ⅱ),Sequential Organ Failure Assessment(SOFA)score,respiratory rate,and shallow breathing index were notably higher in the failure group than in the success group,the duration of mechanical ventilation was less than that of the weaning success group(P＜0.05).Logistic regression analysis denoted that lung ultrasound B-line score,diaphragmatic rapid shallow breathing index,right diaphragmatic excursion,diaphragmatic thickness,APACHE-Ⅱ score,SOFA score,respiratory rate,and rapid shallow breathing index were important factors for successful weaning in critically ill mechanically ventilated patients(P＜0.05).ROC curve indicated that the area under the curve(AUC)of combined test of lung ultrasound B-line score,diaphragmatic rapid shallow breathing index,right diaphragmatic excursion,and diaphragmatic thickness for weaning in critically ill mechanically ventilated patients was 0.931,which was larger than separate test(P＜0.05).Conclusion Lung ultrasound B-line score combined with diaphragm function-related parameters has a high predictive value for weaning in critically ill mechanically ventilated patients.
万方数据
维普
