膈肌超声预测心脏术后急性呼吸窘迫综合征患者撤机的临床研究

Clinical study on diaphragm ultrasound for predicting ventilator withdrawal in patients with acute respiratory distress syndrome after hearty operation

目的探讨超声测量膈肌厚度变化率(TF)和膈肌移动度(DM)对心脏术后急性呼吸窘迫综合征(ARDS)患者撤机的预测价值。方法选择2018年3月至2020年5月在该院行心脏术后出现ARDS的246例患者。撤机前行自主呼吸试验,并用超声评估患者膈肌功能。测量TF、DM、氧合指数(PaO_(2)/FiO_(2))、浅快呼吸指数(RSBI)等。结果撤机成功组209例,撤机失败组37例。撤机成功组与撤机失败组机械通气时间[(18.33±5.54)d vs.(20.77±4.16)d]、最大呼气末膈肌厚度(TdiFRC)[(0.31±0.11)cm vs.(0.25±0.09)cm]、最大吸气末膈肌厚度(TdiFVC)[(0.29±0.07)cm vs.(0.22±0.08)cm]比较差异均无统计学意义(P>0.05)。两组PaO_(2)/FiO_(2)(199.71±69.27 vs.153.77±77.21)有明显差异(P<0.05)。撤机成功组TF明显高于撤机失败组[(40.78±15.77)%vs.(37.65±9.18)%,P<0.01],RSBI明显低于撤机失败组[(74.26±25.61)次·min^(-1)·L^(-1) vs.(89.89±34.51)次·min^(-1) L^(-1),P<0.01]。TF预测成功撤机的灵敏度85.00%,特异度89.03%,AUC为0.809(95%CI:0.749~0.869)。结论膈肌超声可能对心脏术后ARDS患者撤机有预测价值。

Objective To explore the predictive value of diaphragm thickness change rate(TF)and diaphragm muscle mobility(DM)measured by ultrasound in the ventilator withdrawal of the patients with acute respiratory distress syndrome(ARDS)after cardiac surgery.Methods A total of 246 patients with ARDS after cardiac surgery in this hospital from March 2018 to may 2020 were selected.The spontaneous breathing test was performed before the ventilator withdrawal and the diaphragm function was evaluated by ultrasound.TF,DM,oxygenation index(PaO_(2)/FiO_(2)),rapid shallow breathing index(RSBI),etc.were detected.Results There were 209 cases in the ventilator withdrawal success group and 37 cases in the ventilator withdrawal failure group.The mechanical ventilation time in the ventilator withdrawal success group and ventilator withdrawal failure group was(18.33±5.54)d vs.(20.77±4.16)d,TdiFRC(0.31±0.11)cm vs.(0.25±0.09)cm,TdiFVC(0.29±0.07)cm vs.(0.22±0.08)cm,and the differences between the two groups had no statistical significance(P>0.05).There was statistically significant difference in PaO_(2)/FiO_(2) between the two groups(199.71±69.27 vs.153.77±77.21,P<0.05).TF in the ventilator withdrawal success group was higher than that in the ventilator withdrawal failure group[(40.78±15.77)%vs.(37.65±9.18)%,P<0.01].RSBI in the ventilator withdrawal success group was lower than that in the ventilator withdrawal failure group[(74.26±25.61)times·min^(-1)·L^(-1) vs.(89.89±34.51)times·min^(-1)·L^(-1),P<0.01].Conclusion Diaphragmatic ultrasound could have the predictive value for the ventilator withdrawal in the patients with ARDS after cardiac surgery.