摘要
目的 评价基于超声评估的膈肌及其衍生指标在重症肺炎机械通气患者脱机拔管中的预测价值.方法 选取收治的重症肺炎接受有创机械通气治疗的 72 例患者.所有患者均达到脱机标准,在通过自主呼吸试验(SBT)后给予脱机拔管,观察脱机 48 h内患者的呼吸、氧合等状态,并根据脱机结局分为脱机成功组和脱机失败组.比较两组患者的基本资料和脱机前的监测指标;与RSBI作对比,利用受试者工作特征曲线(ROC曲线)评价DD、DTF、D-RSBI三个指标对患者脱机成功的预测价值.结果 脱机成功组机械通气时间(210.40±92.28)h、RR(15.62±3.34)次/min、DD(16.41±3.23)mm、DTF(32.98±7.03)%、D-RSBI(1.19±0.26)次/min·mm,脱机失败组机械通气时间(339.90±126.13)h、RR(18.43±4.86)次/min、DD(14.14±3.10)mm、DTF(24.00±5.53)%、D-RSBI(1.69±0.34)次/min·mm,差异有统计学意义(P<0.05).利用ROC曲线,将尤登指数最大者作为最佳临界值,RSBI最佳临界值为 60.69 次/(min·L),AUCROC为0.79;DD最佳临界值为 12.60 mm,AUCROC为 0.70;DTF最佳临界值为 30.00%,AUCROC为 0.84;D-RSBI最佳临界值为1.36 次/min·mm,AUCROC为 0.87.其中D-RSB预测脱机成功ROC曲线下面积最大,预测价值最优.结论 DD、DTF、D-RSBI对重症肺炎机械通气脱机均有较好的预测价值,其中D-RSBI预测效果最佳.
Abstract
Objective To evaluate the predictive value of diaphragmatic muscle and its derived indicators based on ultra-sonic evaluation in weaning of mechanical ventilation patients with severe pneumonia.Methods The patients with severe pneu-monia admitted who received invasive mechanical ventilation were selected as the study objects.All patients reached the offline standard.After passing the SBT screening,they were given offline decannulation.Their respiratory and oxygenation status within 48 hours of offline were observed.They were divided into offline success group and offline failure group according to the offline outcome.The basic data and monitoring indexes before offline were compared between the two groups;Compared with RSBI,the predictive value of DD,DTF and D-RSBI on the success of weaning was evaluated by using the ROC curve.Results In wean-ing group,mechanical ventilation time was(210.40±92.28)h,RR was(15.62±3.34)times/min,DD was(16.41±3.23)mm,DTF was(32.98±7.03)%,and D-RSBI was(1.19±0.26)times/min·mm.In offline failure group,mechanical ventilation time was(339.90±126.13)h,RR was(18.43±4.86)times/min,DD was(14.14±3.10)mm,DTF was(24.00±5.53)%,and D-RSBI was(1.69±0.34)times/min·mm.There was a statistical difference(P<0.05).Using the ROC curve,taking the largest Youden index as the optimal critical value,the optimal critical value of RSBI was 60.69 times/(min·L),AUCROCwas 0.79;The optimal critical value of DD was 12.60mm,AUCROCwas 0.70;The optimal critical value of DTF was 30.00%,AUCROCwas 0.84;The optimal critical value of D-RSBI was 1.36 times/min·mm,AUCROCwas 0.87.Among them,D-RSBI had the largest area un-der the ROC curve for offline successful prediction and the best prediction value.Conclusion DD,DTF and D-RSBI have good predictive value for weaning from mechanical ventilation in severe pneumonia,of which D-RSBI is the best.
NETL
NSTL
维普
万方数据