M型超声膈肌移动度预测机械通气撤机成功的价值

M-mode ultrasound diaphragmatic mobility predicts the weaning success of mechanical ventilation

目的观察M型超声测量膈肌移动度预测机械通气撤机成功的价值。方法选择上海健康医学院附属周浦医院ICU收治的115例行机械通气并准备撤机的重症患者作为研究对象。对所有患者进行膈肌运动的M型超声检查。根据患者撤机结果分为撤机成功组和撤机失败组。比较两组患者的一般资料和撤机参数。采用多因素Logistic回归分析撤机成功的影响因素,建立ROC曲线分析潜在指标预测撤机结局的准确性。结果撤机成功组81例,撤机失败组34例。多因素Logistic回归分析结果显示RSBI(P=0.000),M型超声左侧膈肌位移(P=0.000)、M型超声右侧膈肌位移(P=0.000)是影响撤机成功的独立影响因素。ROC曲线显示,三者联合预测撤机成功的准确性最高(AUC=0.925),显著大于各撤机参数单独预测撤机成功的AUC(RSBI:0.685,M型超声左侧膈肌位移:0.834,M型超声右侧膈肌位移:0.808),差异有统计学意义(P<0.05)。其敏感度为94.12%,特异度为80.25%,准确度为87.19%。结论M型超声测量膈肌移动度及其与RSBI的联合对预测患者撤机成功与否具有较高的临床价值。

Objective To explore the value of diaphragmatic mobility measured by M⁃mode ultrasound in predicting the weaning success of mechanical ventilation.Methods A total of 115 critically ill patients who underwent mechanical ventilation and prepared for weaning in the ICU of Zhoupu Hospital Affiliated to Shanghai University of Medicine and Health Sciences were recruited.M⁃mode ultrasonography of diaphragmatic movement were performed on all patients.According to the weaning results,patients were divided into the weaning success group and the weaning failure group.General data and weaning parameters were compared between the two groups.Multivariate logistic regression was used to analyze the influencing factors affecting the success of weaning.The ROC curve was used to analyze the potential indicators in predicting the accuracy of the weaning outcome.Results There were 81 cases in the weaning success group and 34 cases in the weaning failure group.Multivariate logistic regression analysis showed rapid shallow breathing index(RSBI)(P=0.000),M⁃mode ultrasound left diaphragm displacement(P=0.000),M⁃mode ultrasound right diaphragm displacement(P=0.000)were the independent influence factors of weaning success.The ROC curve showed that the accuracy of the combination of three indicators predicting the weaning success was the highest(AUC=0.925),which was significantly greater than the AUC of the single weaning indicators(RSBI:0.685,M⁃mode ultrasound left diaphragm displacement:0.834,M⁃mode ultrasound right diaphragm displacement:0.808).The differences were statistically significant(P<0.05).Its sensitivity was 94.12%,specificity was 80.25%,and the accuracy was 87.19%.Conclusions M⁃mode Ultrasound measurement of diaphragm displacement and its combination with RBSI has a high clinical value in predicting weaning success.