多脏器联合超声对机械通气患者撤机的预测价值研究

Predictive value of multi-organ ultrasonography in weaning from mechanical ventilation patients

目的:探讨多脏器联合超声对机械通气患者撤机的预测价值。方法:选取2019年6月至2020年6月某院重症医学科收治的62例机械通气患者,均符合撤机标准进入自主呼吸试验(spontaneous breathing trial,SBT)。所有患者SBT前进行超声检查,记录肺部超声评分(lung ultrasound score,LUS)、舒张早期左房室瓣血流速度/左房室瓣环运动速度(E/e′)、膈肌呼吸浅快指数(diaphragmatic rapid shallow breathing index,DRSBI)。根据能否成功撤机分为成功组和失败组。绘制ROC曲线评估LUS、E/e′、DRSBI及三者联合对撤机失败的预测价值。数据采用SPSS 26.0软件进行统计学分析。结果:62例患者中,撤机成功49例,撤机失败13例。失败组的LUS、E/e′、DRSBI明显高于成功组[(13.23±4.23)分vs(7.32±2.59)分,13.84±1.66 vs 10.67±1.29,1.75±0.26 vs 1.43±0.25],差异均有统计学意义(P<0.001)。LUS≥8.5分时预测撤机失败,敏感度为84.6%、特异度为83.7%,AUC值为0.88;E/e′≥12.7时预测撤机失败,敏感度为84.6%、特异度为91.8%,AUC值为0.93;DRSBI≥1.5时预测撤机失败,敏感度为76.9%、特异度为75.5%,AUC值为0.82;LUS≥8.5分、E/e′≥12.7且DRSBI≥1.5时预测撤机失败,敏感度为100%、特异度为89.8%,AUC值为0.98,高于单项指标检测。结论:多脏器联合超声能有效预测机械通气患者的撤机失败。

Objective To investigate the predictive value of multi-organ ultrasonography in weaning from mechanical venti-lation patients.Methods A total of 62 mechanically ventilated patients admitted to the intensive care unit of some hospital from June 2019 to June 2020 who met the criteria for weaning were selected for the spontaneous breathing trial(SBT).All the patients underwent ultrasound examination before SBT to record such indexes as lung ultrasound score(LUS),mitralvelocity of early filling/early diastolic mitral annular velocity(E/e′)and diaphragmatic rapid shallow breathing index(DRSBI),who were divided into a success group and a failure group according to the weaning results.ROC curve was used to assess the predictive values of LUS,E/e′,DRSBI and the combination of the three indexes for weaning failure.SPSS 26.0 software was used for statistical analysis.Results Weaning was successful in 49 cases and failed in 13 ones.The LUS,E/e′and DRSBI were significantly higher in the failure group than in the success group((13.23±4.23)vs(7.32±2.59),(13.84±1.66)vs(10.67±1.29),(1.75±0.26)vs(1.43±0.25)),and all the differences were statistically significant(P<0.001).For predicting weaning failure the sensitivity,specificity and AUC value were 84.6%,83.7%and 0.88 respectively in case the value of LUS was not lower than 8.5,84.6%,91.8%and 0.93 respectively in case the value of E/e′was not lower than 12.7,76.9%,75.5%and 0.82 respectively in case the value of DRSBI was not lower than 1.5,and 100%,89.8%and 0.98 in case all the above three conditions were met.It's proved that the values of the sensitivity,specificity and AUC value by the combined indexes than those by LUS,E/e′or DRSBI.Conclusion Multi-organ ultrasonography can effectively predict weaning failure in mechanical ventilation patients.