重症超声评估左心室舒张功能对机械通气患者撤机结果的预测价值

Predictive value of left ventricular diastolic function assessed by severe ultrasound in patients with mechanical ventilation after weaning

目的探究重症超声评估左心室舒张功能对机械通气患者撤机结果的预测价值。方法选取本院ICU 2018年1月至2019年6月收治的74例患者作为研究对象,根据撤机结果分为A组(撤机成功,n=45)与B组(撤机失败,n=29)。比较两组撤机前体征情况及超声检查结果。结果A组患者呼吸频率(RR)、心率(HR)等指标低于B组,氧合指数高于B组(P<0.05),两组平均动脉压(MAP)、中心静脉压(CVP)、pH等体征比较差异无统计学意义;B组侧壁E/Em、间隔E/Em指标均高于A组(P<0.05);两组左心室射血分数(LVEF)、左室间隔厚度(IVSTD)、左室后壁厚度(LVPWTD)、E峰减速时间(DTE)、左室二尖瓣口舒张早期(E峰)等指标比较差异无统计意义。结论在重症患者中,左心室舒张功能对机械通气患者撤机结果有重要影响,合理应用重症超声评估左心室舒张功能相关参数,如侧壁E/Em、间隔E/Em等指标,可为临床早期识别撤机失败高风险患者提供科学依据,具有一定预测价值。

Objective To explore the predictive value of left ventricular diastolic function in severe ultrasound in predicting the outcome of weaning patients with mechanical ventilation.Methods 74 patients admitted to our hospital from January 2018 to June 2019 were selected as the research subjects;according to the results of weaning,they were divided into group A(successful withdrawal,n=45)and group B(withdrawal failure,n=29).The signs and ultrasound results between the two groups before weaning were compared.Results The respiratory rate(RR)and heart rate(HR)in group A were lower than those in group B,and the oxygenation index was higher than group B(P<0.05).There was no statistically significant difference in mean arterial pressure(MAP),central venous pressure(CVP)and pH;the side wall E/Em and interval E/Em indicators in group B were higher than those of group A(P<0.05);there was no statistically significant difference in left ventricular ejection fraction(LVEF),left ventricular septal thickness(IVSTD),left ventricular posterior wall thickness(LVPWTD),E-peak deceleration time(DTE)and early left ventricular mitral valve diastole(E-peak).Conclusion In critically ill patients,left ventricular diastolic function has an important effect on the outcome of weaning patients with mechanical ventilation.Reasonable application of severe ultrasound to evaluate left ventricular diastolic function-related parameters,such as sidewall E/Em,interval E/Em,etc.Early clinical identification of patients at high risk of failure to withdraw provides scientific evidence and has certain predictive value.