膈肌增厚分数联合浅快呼吸指数指导脓毒症机械通气患者撤机时机的价值研究

Value of diaphragmtic thickening fraction combined with shallow rapid breathing index in guiding the timing of weaning from mechanical ventilation in patients with sepsis

目的探讨膈肌增厚分数(diaphragmtic thickening fraction,DTF)联合呼吸浅快指数(rapid shallow breathing index,RSBI)指导脓毒症机械通气患者撤机时机的应用价值。方法采用前瞻性研究方法,选取2020年1月至2022年4月嘉兴市第一医院(嘉兴学院附属医院)重症医学科收治的103例脓毒症机械通气患者,所有患者均符合撤机标准,根据撤机结果将其分为撤机成功组(n=67)和撤机失败组(n=36)。两组患者均进行自主呼吸试验(spontaneous breathing trial,SBT)30min后,记录呼吸频率及潮气量,计算RSBI,通过超声测量吸气末和呼气末膈肌厚度,计算DTF,绘制受试者操作特征(receiver operating characteristic,ROC)曲线评估DTF、RSBI及联合指标对撤机时机的预测价值。结果撤机成功组患者的DTF显著高于撤机失败组[(24.98±4.70)%vs(19.66±5.31)%],差异有统计学意义(P<0.001);撤机成功组患者的RSBI显著低于撤机失败组[(52.67±13.65)次/(min·L)vs(70.82±20.78)次/(min·L)],差异有统计学意义(P<0.001),DTF、RSBI及联合指标对成功撤机有预测效能,以DTF>21.20%且RSBI≤55.56次/(min·L)作为联合指标的预测效能最大。结论DTF及RSBI能有效预测脓毒症机械通气患者的成功撤机时机,与单一DTF及RSBI相比,联合指标可显著提高成功撤机的预测效能。

Objective To investigate the value of diaphragmtic thickening fraction(DTF)combined with rapid shallow breathing index(RSBI)in guiding the timing of weaning in sepsis patients with mechanical ventilation.Methods A prospective study was conducted,103 sepsis patients with mechanical ventilation who were admitted to the Department of Critical Care Medicine,the First Hospital of Jiaxing(Affiliated Hospital of Jiaxing University)from January 2020 to April 2022 were selected,all patients met the weaning criteria,they were divided into success weaning group(67 cases)and failure weaning group(36 cases).After 30 minutes of spontaneous breathing trial(SBT),the respiratory rate and tidal volume were recorded,and RSBI was calculated.The diaphragm thickness was measured by ultrasound at the end of inspiratory and the end of expiratory,and the DTF was calculated.The receiver operating characteristic(ROC)curve was drawn to evaluate the predictive value of DTF,RSBI and combined indicators for weaning outcomes.Results The DTF of the success weaning group was significantly higher than that of the failure weaning group[(24.98±4.70)%vs(19.66±5.31)%],the difference was statistically significant(P<0.001).The RSBI of the success weaning group was significantly lower than that of the failure weaning group[(52.67±13.65)times/min·L vs(70.82±20.78)times/min·L],and the difference was statistically significant(P<0.001);DTF,RSBI and the combined index had the prediction efficiency for the successful weaning,and the prediction efficiency is the greatest when DTF>21.2%combined RSBI≤55.56 times/min·L.Conclusion DTF and RSBI can effectively predict the timing of weaning in sepsis patients with mechanical ventilation.Compared with single DTF and RSBI,the combined index significantly improves the predictive value of successful weaning.