心肺联合超声在先天性心脏病婴儿术后机械通气脱机评估中的临床价值

Application Value of Cardiopulmonary Ultrasound in Predicting the Weaning From Mechanical Ventilation in Infants After Cardiac Surgery

目的:探讨心肺联合超声(CPUS)在先天性心脏病(先心病)婴儿术后机械通气脱机评估中的临床应用价值。方法:选取2020年2~6月在中国医学科学院阜外医院经外科手术治疗先心病婴儿109例,平均年龄(0.70±0.25)岁,平均体重(7.48±1.49)kg。达到临床脱机标准后进行心肺联合超声检查,记录肺超声评分、左心室射血分数(LVEF)、肺动脉收缩压、畸形矫治情况与膈肌运动情况。同时记录临床监测以及血气分析指标,N末端B型利尿肽原(NTproBNP)。根据是否成功脱机分为脱机成功组(n=84)及脱机失败组(n=25),比较两组间参数,评价心肺联合超声参数对脱机失败的预测效能。结果:脱机成功组和脱机失败组性别、术前LVEF、心率、平均动脉压、中心静脉压、动脉血二氧化碳分压、合并肺动脉高压者差异无统计学意义(P均>0.05)。脱机失败组术后LVEF、动脉血氧分压低于脱机成功组,肺超声评分、NT-proBNP以及合并膈肌功能障碍者高于脱机成功组(P均<0.05)。以肺超声评分为标准预测脱机失败的ROC曲线下面积为0.84,最佳截断值为13分,敏感度为60%,特异度91%。Logistic回归分析示肺超声评分≥13分,LVEF<40%及膈肌功能障碍均与脱机失败显著相关(P均<0.05),联合预测脱机失败的ROC曲线下面积为0.88。结论:床旁心肺联合超声对先心病术后婴儿预测呼吸机撤离具有较高的可操作性及诊断价值。

Objectives:To investigate the role of cardiopulmonary ultrasound in predicting the weaning from mechanical ventilation in infants after cardiac surgery.Methods:A total of 109 infants with congenital heart disease(CHD)who underwent surgical treatment from February 2020 to June 2020,in Fuwai Hospital were included.The mean age was(0.70±0.25)years and mean weight was(7.48±1.49)kg.After reaching the clinical weaning standard,cardiopulmonary ultrasound(CPUS)examination was performed to assess the lung ultrasound score(LUS),left ventricular ejection fraction(LVEF),pulmonary artery systolic pressure,cardiac malformation,and diaphragmatic movement.Clinical data,blood gas analysis and N-terminal brain natriuretic peptide(NTproBNP)were also collected.Patients were divided into two groups:successful extubation group(n=84)and extubation failure group(n=25).Parameters between the two groups were compared to evaluate the predictive performance of the CPUS for extubation failure.Results:There was no significant difference between the successful extubation group and the extubation failure group in gender,preoperative LVEF,heart rate,mean arterial pressure,central venous pressure,arterial partial pressure of carbon dioxide,and pulmonary hypertension(all P>0.05).The LVEF and arterial partial pressure of oxygen before extubation were significantly lower while the LUS score,NT-proBNP,and incidence of diaphragmatic dysfunction were significantly higher in the extubation failure group than those in the successful group(all P<0.05).The area under the ROC curve to predict the extubation failure based on the LUS score was 0.84.The best cutoff value was 13.The sensitivity and the specificity was 60% and 91%,separately.Logistic regression analysis showed that LUS≥13,LVEF<40%,and diaphragmatic dysfunction were risk factors of extubation failure(P<0.05).Combining all 3 factors together,the area under the ROC curve was 0.88.Conclusions:Bedside CPUS is feasible and has a high diagnostic value to predict ventilator weaning success or failure in infants after CHD surgery.