肺超声评分评估呼吸窘迫综合征极低出生体重儿机械通气成功撤离的价值

Value of lung ultrasound score in assessing successful weaning of mechanical ventilation in very low body weight infants with respiratory distress syndrome

目的探讨肺超声评分(LUS)评估呼吸窘迫综合征(NRDS)极低出生体重儿(VLBWI)机械通气成功撤离的价值。方法收集136例使用有创机械通气的VLBWI,根据患儿撤机结局不同分为撤机成功组(n=114)和撤机失败组(n=22),回顾性分析患儿基本情况,血气分析及LUS等临床资料,对比分析不同指标数据与患儿撤机结局的相关性,应用ROC曲线评价LUS预测NRDS、VLBWI撤机成功与否的价值。结果撤机成功组呼吸机使用时间为(9.3±4.2)d,明显低于撤机失败组的(18.2±11.3)d(P<0.001)。撤机成功组合并动脉导管未闭(PDA)的比例(36.8%)也较撤机失败组(68.2%)低(P<0.05)。撤机成功组患儿的动脉血氧分压(PaO_(2))、氧合指数(PaO_(2)/FiO_(2))均高于撤机失败组(P<0.001),撤机成功组患儿动脉血二氧化碳分压(PaCO_(2))低于撤机失败组(P<0.001)。LUS结果提示撤机成功组患儿撤机前LUS[(4.9±0.7)分]低于撤机失败组患儿的(7.5±1.6)分(P<0.001)。LUS与PaCO_(2)呈正相关(r=0.470,P<0.001),与PaO_(2)、PaO_(2)/FiO_(2)呈负相关(r=-0.633,P<0.001;r=-0.460,P<0.001)。当LUS<5.5分时,预测撤机成功灵敏度81.6%,特异度为81.8%,受试者工作特征(ROC)曲线下面积(AUC)为0.895[95%CI(0.799~0.990),P<0.001]。结论LUS与动脉血气分析有一定相关性,可作为评估NRDS VLBWI的撤机指标,且联合血气分析结果能够全面有效指导临床早期识别撤机失败高风险因素,预防撤机失败发生。

Objective To explore the value of lung ultrasound score in assessing successful weaning of mechanical ventilation in very low body weight infants(VLBWI)with neonates respiratory distress syndrome(NRDS).Methods One hundred and thirty-six VLBWI with invasive mechanical ventilation were collected and divided into the mechanical ventilation weaning success group(n=114)and the mechanical ventilation weaning failure group according to the outcomes of machine weaning.The clinical data of general conditions,blood gas analysis and lung ultrasound score(LUS)were retrospectively analyzed.The correlation between different indicators and outcome of machine weaning was comparatively analyzed.The receiver operating characteristic(ROC)curve was used to evaluate the value of LUS in predicting the outcome of machine weaning in VLBWI.Results The breathing machine use time in the machine weaning success group was(9.3±4.21)d,which was significantly lower than(18.2±11.3)d in the machine weaning failure group(P<0.001).The ratio of complicating patent ductus arteriosus(PDA)in the machine weaning success group was also lower than that in the machine weaning failure group(36.8%vs.68.2%,P<0.05).The levels of PaO_(2),PaO_(2)/FiO_(2) in the machine weaning success group were all higher than those in the machine weaning failure group(P<0.001),and PaCO_(2) in the machine weaning success group was lower than that in the machine weaning failure group(P<0.001).The LUS results showed that the LUS score before the machine weaning in the machine weaning success group was lower than that in the machine weaning failure group[(4.9±0.73)points vs.(7.5±1.60)points,P<0.001].LUS was positively correlated with PaCO_(2)(r=0.470,P<0.001)and negatively correlated with PaO_(2) and PaO_(2)/FiO_(2)(r=-0.633,P<0.001;r=-0.46,P<0.001).When LUS<5.5 points,the sensitivity of predicting the machine weaning success was 81.6%,the specificity was 81.8%,the area under the receiver operating characteristic(ROC)curve was 0.895[95%CI(0.799,0.990),P<0.001].Conclusion LUS has a certain correlation with the arterial blood gas analysis,which could serve as a indicator for evaluating the machine weaning in VLBWI,its combination with the blood gas analysis results could comprehensively and effectively guide the clinic to early identify the high risk factor of machine weaning failure and prevent the occurrence of machine weaning failure.