膈肌超声评估与跨膈压对慢性阻塞性肺疾病急性加重期患者接受无创通气结局的预测价值研究

Predictive value of diaphragmatic ultrasound evaluation and transdiaphragmatic pressure for the outcome of noninvasive ventilation in patients with acute exacerbation of chronic obstructive pulmonary disease

目的探讨慢性阻塞性肺疾病急性加重期(AECOPD)进行无创通气的患者采用超声评估膈肌功能障碍的临床应用效果,分析膈肌超声评估(DUS)和跨膈压(Pdi)的相关性及其对预后的评估价值。方法选择2018年2月至2019年9月,锦州医科大学附属第三医院73例AECOPD无创机械通气治疗患者,根据无创通气上机结局分为上机成功组(54例)和上机失败组(19例),比较两组患者接受无创通气后2 h、24 h、48 h膈肌增厚分数(ΔTdi)、Pdi_(max)与血清白蛋白(Alb)的变化趋势,分析ΔTdi与Pdi_(max)的相关性,并比较2 h后ΔTdi、Pdi_(max)与pH<7.25对无创通气结局的预测价值。结果成功组ΔTdi、Pdi_(max) 24 h、48 h与2 h相比,显著上升,差异均有统计学意义(均P<0.05),失败组ΔTdi、Pdi_(max)呈现显著下降趋势(均P<0.05);上机2 h、24 h和48 h两组Alb比较,差异无统计学意义(均P>0.05);上机2 h、24 h、48 hΔTdi与Pdi_(max)呈正相关(r=0.261、0.288、0.674,P<0.05)。受试者工作特征曲线(ROC)显示,ΔTdi、Pdi_(max)与pH<7.25对AECOPD患者无创通气结局均有预测价值,ROC曲线下面积分别为0.830、0.855、0.740(P<0.05)。结论ΔTdi和Pdi_(max)具有早期预测AECOPD患者无创通气结局的价值,为进一步指导AECOPD无创通气早期救治提供理论依据。

Objective To investigate the clinical application effect of ultrasonic assessment of diaphragmatic dysfunction in patients with non-invasive ventilation for acute exacerbation of chronic obstructive pulmonary disease(AECOPD),and to analyze the correlation between diaphragmatic ultrasound(DUS)and transphrenic pressure(Pdi)and their value for prognosis evaluation.Methods Totally 73 patients with AECOPD treated with noninvasive mechanical ventilation in the Third Affiliated Hospital of Jinzhou Medical University from February 2018 to September 2019 were divided into successful group(54 cases)and failed group(19 cases)according to the outcomes of non-invasive ventilation.The variation trends of diaphragm thickness(ΔTdi),Pdi_(max) and serum albumin(Alb)were compared between the two groups after 2 h,24 h and 48 h non-invasive ventilation.The correlation betweenΔTdi and Pdi_(max) was analyzed,and the value of the pH<7.25,ΔTdi and Pdi_(max) in predicting the outcome of non-invasive ventilation after 2 hours was compared.Results In the successful group,ΔTdi and Pdi_(max) at 24 h and 48 h were significantly increased compared with that at 2 h,with statistical difference(all P<0.05),while in the failed group,ΔTdi and Pdi_(max) were significantly decreased(all P<0.05).There was no statistical difference in Alb between the two groups at 2 h,24 h and 48 h(P>0.05).There was significant positive correlation betweenΔTdi and Pdi_(max) at 2 h,24 h and 48 h(r=0.261,0.288,0.674,P<0.05).The ROC curve showed thatΔTdi,Pdi_(max) and pH<7.25 all had predictive value for the outcome of noninvasive ventilation in AECOPD patients,and the areas under the ROC curve were 0.830,0.855,0.740(P<0.05).ConclusionΔTdi and Pdi_(max) has predictive value of the outcome of non-invasive ventilation in patients with AECOPD in early stage,which provides a basis for further guiding the early treatment with noninvasive ventilation in AECOPD.