超声评估呼吸肌活动度在呼吸衰竭患者撤机中的价值

Ultrasonographic evaluation of respiratory muscle activity in patients with respiratory failure

目的:探讨超声评估呼吸肌活动度在预测呼吸衰竭患者撤机中的价值。方法:选择本院ICU收治的118例患者为观察对象,根据患者撤机结果分为成功组和失败组。在常规检查的基础上采用M型超声测量患者在仰卧位时的膈肌位移。记录患者的一般临床资料、基础疾病、呼吸功能相关指标及膈肌超声测量结果并进行两组对比。采用Logistic回归进一步筛选影响撤机成功的潜在独立影响因素。利用ROC曲线评估潜在指标预测呼吸衰竭患者撤机成功的效能。结果:撤机成功组84例,撤机失败组34例。潮气量(OR=1.015)、MIP(OR=0.765)、左侧膈肌位移(OR=0.765)、右侧膈肌位移(OR=0.854)和平均膈肌位移(OR=0.679)可以预测撤机成功(均P<0.05)。平均膈肌位移和潮气量(r=0.787,P=0.000)、MIP(r=0.771,P=0.000)的相关性最高。ROC曲线分析发现,平均膈肌位移的曲线下面积(AUC)最高,其最佳诊断点为8.25mm,敏感度为58.8%,特异度为86.9%。结论:超声可早期发现膈肌功能障碍,在指导撤机方面膈肌位移优于传统参数。

Objective：The purpose of this study was to evaluate the value of ultrasound in assessing respiratory muscle activity in predicting weaning from mechanical ventilation in patients with respiratory failure.Methods：One hundred and eighteen patients admitted to the ICU in our hospital were involved as research objects.According to the patient＇s weaning results,the patients were divided into success group and failure group.On the basis of routine examinations,M-mode ultrasound was used to measure the diaphragm displacement in the supine position.The patient＇s general clinical data,basic diseases,respiratory function related indicators,and diaphragmatic ultrasound measurements were recorded and compared.Logistic regression was used to further screening of potential independent influencing factors affecting the success of weaning.The potential indicators to predict the accuracy of weaning in patients with respiratory failure were evaluated by ROC curve.Results：There were 84 cases in the success group and 34 cases in the failure group.Tidal volume（OR=1.015）,MIP（OR=0.765）,left（OR=0.765）,right（OR=0.854）and mean diaphragm displacement（OR=0.679）had a significant effect on the prediction of weaning success（P〈0.05）.The correlation between mean diaphragm displacement and tidal volume（r=0.787,P=0.000）and MIP（r=0.771,P=0.000）was the highest.It was found,from ROC curve analysis,that the AUC of mean diaphragmatic displacement was the highest.The best diagnostic point was 8.25 mm.The sensitivity was 58.8%,and the specificity was86.9%.Conclusion：Ultrasonography can detect early diaphragmatic muscle dysfunction.The effect of diaphragm displacement in guiding weaning may be superior to traditional parameters.