肺超声评分预测重症呼吸支持患者撤机成功的临床价值

Clinical value of lung ultrasound score in predicting weaning success in patients with severe respiratory support

目的探讨肺超声评分预测重症呼吸支持患者撤机成功的临床价值。方法选取我院重症呼吸支持患者86例,根据撤机结局分为撤机成功组64例和撤机失败组22例。比较两组撤机前一般资料、肺超声评分、氧分压(PaO2)、氧合指数(PaO2/FiO2)、二氧化碳分压(PaCO2)、动脉血酸碱度(pH);应用Logistic回归分析撤机结局的影响因素;分析肺超声评分与动脉血气分析指标的相关性;绘制受试者工作特征曲线分析肺超声评分预测撤机成功的价值,并以柱状图分析撤机成功率。结果撤机成功组撤机前液体负平衡、膈肌移动度、PaO2、PaO2/FiO2均高于撤机失败组,肺超声评分、心率、PaCO2均低于撤机失败组,差异均有统计学意义(均P<0.05)。Logistic回归分析显示,撤机前液体负平衡、心率、肺超声评分、PaO2、PaO2/FiO2、PaCO2均与撤机结局相关(均P<0.05)。肺超声评分与PaCO2呈正相关(r=0.677,P<0.05),与PaO2、PaO2/FiO2均呈负相关(r=-0.850、-0.634,均P<0.05)。肺超声评分>19.47分预测重症呼吸支持患者撤机成功的曲线下面积为0.784,敏感性为54.55%,特异性为95.31%。结论肺超声评分对重症呼吸支持患者成功撤机具有一定预测价值。

ObjectiveTo explore the value of lung ultrasound score in predicting weaning success in patients withsevere respiratory support.MethodsA total of 86 patients with severe respiratory support were selected,and they were dividedinto successful weaning group with 64 cases and weaning failure group with 22 cases according to the results of weaning.Thegeneral information,lung ultrasound score,oxygen partial pressure(Pa O2),oxygenation index(Pa O2/Fi O2),carbon dioxide partialpressure(Pa CO2)and p H of arterial blood(p H)in two groups before weaning were compared.The factors influencing theoutcome of weaning were analyzed by Logistic regression,and the correlation between lung ultrasound scores and arterial bloodgas analysis indexes were analyzed.The value of lung ultrasound score in predicting the weaning success was analyzed byreceiver operating characteristic(ROC)curve.The success rate of weaning was analyzed by histogram.ResultsThe negativefluid balance,diaphragm mobility,Pa O2,Pa O2/Fi O2 in the successful weaning group before weaning were higher than those in theweaning failure group,and lung ultrasound scores,heart rate and Pa CO2 were lower than those in the weaning failure group,andthe differences were statistically significant(all P<0.05).Logistic regression analysis showed that the negative fluid balance,heart rate,lung ultrasound score,Pa O2,Pa O2/Fi O2,and Pa CO2 before weaning were all related to the outcome of weaning(allP<0.05).The lung ultrasound score was positively correlated with Pa CO2(r=0.677,P<0.05),and negatively correlated with Pa O2,Pa O2/Fi O2(r=-0.850,-0.634,both P<0.05).When the cut-off value>19.47 point,the AUC of lung ultrasound score inpredicting weaning sucess in patients with severe respiratory support was 0.784,the sensitivity was 54.55%,and the specificitywas 95.31%.ConclusionThe lung ultrasound score has a certain value in predicting the weaning success in patients withsevere respiratory support.