床旁超声监测膈肌功能对COPD机械通气患者撤机结果的预测价值

Value of bedside ultrasound monitoring of diaphragmatic function for the predictive outcome of withdrawal of mechanical ventilation in patients with COPD

目的:探讨床旁M型超声监测膈肌运动功能对接受机械通气治疗慢性阻塞性肺疾病(COPD)患者撤机结果的预测价值。方法:将68例接受机械通气治疗的COPD患者纳入研究,根据撤机随访结果分为撤机成功组(n=47)和撤机失败组(n=21),比较两组患者临床基本资料和上述膈肌超声指标的差异,并通过受试者工作特征(ROC)曲线分析常规撤机参数和膈肌运动功能超声指标对撤机失败的预测价值。结果:撤机成功组呼吸频率、RSBI和D-RSBI均低于撤机失败组,DE、DTF均高于撤机失败组(P<0.05);构建ROC曲线分析可知,呼吸频率、RSBI、DE、DTF和D-RSBI指标对撤机失败均有较好预测价值。结论:床旁M型超声能较好评估接受机械通气治疗COPD患者的膈肌运动功能,利用膈肌超声监测指标对撤机结果进行预测的准确性较好。

Objective:To investigate the value of bedside M-mode ultrasound monitoring of diaphragmatic motor function for the predictive outcome of withdrawal of mechanical ventilation in patients with chronic obstructive pulmonary disease(COPD).Methods:Sixty-eight patients with COPD treated with mechanical ventilation were included in this study and were divided into a successful withdrawal group(n=47)and a failed withdrawal group(n=21)according to the results of withdrawal follow-up.The differences in basic clinical information and the above-mentioned diaphragmatic ultrasound indicators were compared between the two groups,and the predictive value of conventional withdrawal parameters and diaphragmatic motor function ultrasound indicators for withdrawal failure was analyzed by receiver operating characteristic(ROC)curve.Results:Respiratory rate,RSBI and D-RSBI were lower and DE and DTF were higher in the successful withdrawal group than the failed withdrawal group(P<0.05).The ROC curve analysis showed that respiratory rate,RSBI,DE,DTF and D-RSBI indicators all had a good predictive value for withdrawal failure.Conclusion:Bedside M-mode ultrasound can better assess the diaphragm motor function in COPD patients receiving mechanical ventilation,and the accuracy using diaphragm ultrasound monitoring indicators to predict the outcome of withdrawal is good.