膈肌和肋间肌增厚率及肋间肌代偿指数评估老年机械通气患者呼吸肌功能

Diaphragm,intercostal muscle thickening fraction and intercostal muscle compensatory index for evaluating respiratory muscle function in elderly patients with mechanical ventilation

目的观察超声监测膈肌增厚率(DTF)、肋间肌增厚率(ICMTF)及肋间肌代偿指数(ICMTF/DTF)评估老年机械通气患者呼吸肌功能的价值。方法对危重监护病房的34例老年机械通气患者(机械通气组)根据其机械通气时间分为长期(时间≥30 d)通气亚组(n=15)与短期(3 d≤时间<30 d)通气亚组(n=19);另以28名既往无肺部及严重心脏疾病的自主呼吸老年志愿者为自主呼吸组。采用床旁超声监测受试者呼吸周期内膈肌吸气末厚度(DTei)、呼气末厚度(DTee)及肋间肌吸气末厚度(ICMTei)和呼气末厚度(ICMTee),计算DTF、ICMTF及ICMTF/DTF,比较组间及亚组间各指标差异,分析其评价呼吸肌功能的价值。结果长期通气亚组DTei、DTee和DTF均明显低于短期通气亚组(P均<0.05),而两亚组均明显低于自主呼吸组(P均<0.05);长期通气亚组ICMTei、ICMTee、ICMTF和ICMTF/DTF均明显高于自主呼吸组(P均<0.05),且ICMTei高于短期通气亚组(P<0.05),而两亚组间ICMTee、ICMTF和ICMTF/DTF差异均无统计学意义(P均>0.05)。所有受试者DTF与ICMTF呈负相关(r=-0.405,P<0.05)。结论采用DTF、ICMTF和ICMTF/DTF均可有效评估呼吸肌功能。

Objective To observe the value of ultrasound monitoring diaphragm thickening fraction(DTF),intercostal muscle thickening fraction(ICMTF)and intercostal muscle compensatory index(ICMTF/DTF)for evaluating respiratory muscle function in elderly patients with mechanical ventilation.Methods A total of 34 elderly patients who underwent mechanical ventilation in the intensive care unit(mechanical ventilation group)were enrolled and divided into long-term(≥30 d)ventilation subgroup(n=15)and short-term(3 d≤time<30 d)ventilation subgroup(n=19)according to mechanical ventilation time.Meanwhile,28 elderly people without previous lung or serious heart diseases were selected as spontaneous breathing group.Diaphragm thickness at end of inspiration(DTei),diaphragm thickness at the end of expiration(DTee),intercostal muscle thickness at the end inspiration(ICMTee)and intercostal muscle thickness at the end expiration(ICMTee)were measured,and DTF,ICMTF and ICMTF/DTF were calculated.The above indexes were compared between groups and subgroups,and the values of evaluation of respiratory muscles function were analyzed.Results DTei,DTee and DTF in long-term ventilation subgroup were significantly lower than those in short-term ventilation subgroup(all P<0.05),while those in 2 subgroup were significantly lower than those in spontaneous breathing group(all P<0.05).ICMTei,ICMTee,ICMTF and ICMTF/DTF in long-term ventilation subgroup were significantly higher than those in spontaneous breathing group(all P<0.05),and ICMTei was higher than that in short-term ventilation subgroup(P<0.05),but ICMTee,ICMTF and ICMTF/DTF were not significantly different between 2 subgroups(all P>0.05).There was a negative correlation between DTF and ICMTF(r=-0.405,P<0.05).Conclusion DTF,ICMTF and ICMTF/DTF could be used as effective indexes for evaluating respiratory muscles.