膈肌增厚分数联合浅快呼吸指数对COPD伴呼吸衰竭机械通气患者脱机的预测效果

Predictive effect of diaphragmatic thickening fraction combined with rapid shallow breathing index on weaning from mechanical ventilation in patients with COPD complicated by respiratory failure

目的探讨膈肌增厚分数(DTF)联合浅快呼吸指数(RSBI)对慢性阻塞性肺疾病(COPD)伴呼吸衰竭患者脱机的预测效果。方法抽取2019年5月至2022年5月郑州市第七人民医院收治的COPD伴呼吸衰竭患者84例,均给予有创机械通气治疗,其中撤机后48 h内需再插管者41例(对照组),无需再插管者43例(观察组)。两组均给予自主呼吸试验和超声监测,测定DTF与RSBI。评估DTF、RSBI单项及联合预测脱机的价值。结果脱机前,观察组DTF高于对照组(t=6.57,P<0.05),观察组RSBI低于对照组(t=8.42,P<0.05)。DTF、RSBI单项及联合预测脱机结果显示,联合预测脱机灵敏度高于DTF(χ^(2)=4.07,P=0.044),但DTF预测脱机特异度高于RSBI及二者联合预测(χ^(2)=14.99、14.98,P均<0.001)。结论COPD伴呼吸衰竭患者有创机械通气脱机预测中DTF与RSBI均有一定的预测价值,但二者联合预测有更高的灵敏度,可进一步提升脱机预测成功率。

Objective To investigate the predictive effect of diaphragmatic thickening fraction(DTF)combined with rapid shallow breathing index(RSBI)on weaning from mechanical ventilation in patients with chronic obstructive pulmonary disease(COPD)complicated by respiratory failure.Methods A total of 84 patients with COPD complicated by respiratory failure admitted to Zhengzhou Seventh People’s Hospital from May 2019 to May 2022 were selected,all of whom were given invasive mechanical ventilation.Among them,41 cases required re-intubation within 48 hours after weaning(control group),and 43 cases did not need re-intubation(observation group).Both groups were given spontaneous breathing test and ultrasound monitoring to detect DTF and RSBI.The value of DTF,RSBI alone and combination of them in predicting success of weaning were evaluated.Results Before weaning,the DTF of the observation group was higher than that of the control group(t=6.57,P<0.05),and the RSBI of the observation group was lower than that of the control group(t=8.42,P<0.05).The results of DTF,RSBI alone and combination of them in predicting success of weaning showed that the sensitivity of the combination was higher than that of DTF(χ^(2)=4.07,P=0.044),however,the specificity of DTF was higher than that of RSBI and the combination(χ^(2)=14.99,14.98;all P<0.001).Conclusions In the prediction on weaning from invasive mechanical ventilation in COPD patients with respiratory failure,DTF and RSBI both have certain predictive value,but the combination of the two has a higher sensitivity,and can further improve the success rate of prediction on weaning.