两种超声评估方式在呼吸重症患者撤机评价中的价值

Value of two ultrasound assessment methods in the evaluation of weaning in critically ill respiratory patients

目的探讨膈肌功能和超声B线评分在判断重症患者撤机成败及对撤机结果的影响。方法本研究为病例对照研究,采用非随机抽样的方法选取南通大学第二附属医院2021年4月至12月收治的机械通气并准备进行撤机处理的重症患者66例。根据患者撤机是否成功分为撤机成功组52例和撤机失败组14例。收集患者撤机前的临床病理特征资料,比较2组患者膈肌移动度、膈肌增厚率和B线评分。采用受试者工作特征曲线,分别对这3种指标在撤机预测的准确度、特异度和阳性预测值进行分析和评价。结果撤机成功组的急性生理功能和慢性健康状况评分系统Ⅱ和左心房压值均较撤机失败组降低,分别为(17.9±5.2)分比(22.8±4.5)分、(14.7±3.1)mmHg比(88.2±11.1)mmHg(t值分别为3.22、42.69,P值均<0.05)。撤机成功组患者膈肌移动度和膈肌增厚率较撤机失败组升高,分别为(1.8±0.6)cm比(1.2±0.7)cm、(0.33±0.1)%比(0.26±0.1)%(t值分别为3.39、2.46,P值均<0.05),而超声B线评分较撤机失败组降低,为(8.5±3.0)分比(12.9±2.2)分(t值为5.23,P<0.05)。在使用受试者工作特征曲线评价膈肌功能和超声B线评分对患者撤机预测的准确度上,结果显示超声B线评分对患者撤机预测的曲线下面积0.89、敏感度71.2%、特异度100%和阳性预测值100%,均最高。结论膈肌功能和超声B线评分这两种超声评估方式对重症患者撤机均有较好的预测价值,而在准确度上超声B线评分具有更好的预测价值。

Objective To explore the effects of diaphragmatic function and ultrasonic B-line score on the successful or failed withdrawal of intensive care unit(ICU)patients.Methods This is a case-control study,and non-random sampling method was applied to select 66 ICU patients who were admitted by The Second Affiliated Hospital of Nantong University from April 2021 to December 2021 for mechanical ventilation and prepared withdrawal.The patients were divided into the weaning success group with 52 cases and the weaning failed group with 14 cases based to the success availability of withdrawal.The clinicopathological characteristic data of patients before withdrawal were acquired,and the diaphragmatic displacement(DD),diaphragm thickening rate and B-line score of patients in two groups were compared.Receiver operating characteristic curve(ROC)was used to analyze and evaluate the accuracy,specificity and positive predictive value of the three indicators in the prediction of weaning.Results Compared with the weaning failed group,the acute physiology and chronic health evaluation Ⅱ(APACHEⅡ)scoring syste mand left-atrial pressure in the weaning success group were lowered,hitting(17.9±5.2)scores vs(22.8±4.5)scores,(14.7±3.1)mmHg vs(88.2±11.1)mmHg(t valued was 3.22 and 42.69,respectively,all,P<0.05);DD and diaphragm thickening rate of patients in the weaning success group were elevated hitting(1.8±0.6)cm vs(1.2±0.7)cm,(0.33±0.1)%vs(0.26±0.1)%(t valued 3.39 and 2.46,respectively,all P<0.05);and the B-line scores in the Weaning success group was lowered,hitting(8.5±3.0)scores vs(12.9±2.2)scores(t value was 5.23,P<0.05).The findings of ROC curve used to evaluate the accuracy of diaphragmatic function and B-line score in the withdrawal showed that the area under curve(AUC),sensitivity,specificity and positive predictive value of ultrasonic B-line score in the prediction of withdrawal was 0.89,71.2%,100% and 100%,respectively,and all the indicators were the maximum.Conclusions Both diaphragmatic function and ultrasonic B-line score deliver good predictive value in the withdrawal of ICU patients,and ultrasonic B-line score delivers better predictive value in terms of the accuracy.