组织多普勒成像技术评价膈肌功能对机械通气撤机结果的预测价值

Predictive Value of Diaphragmatic Function Evaluated by Tissue Doppler Imaging on Weaning Outcome of Mechanical Ventilation

目的:应用组织多普勒成像技术评估机械通气患者的膈肌功能,评价该技术对撤机结果的预测价值。方法:本研究共纳入2022年1月-2022年12月宜昌市中心人民医院重症监护室有创机械通气的患者115例,根据撤机结局分为撤机成功组85例,撤机失败组30例。所有患者撤机前均接受并通过自主呼吸试验(SBT),记录撤机时呼吸机指标,包括呼吸频率(RR)、最大吸气压(MIP)、吸气0.1 s口腔闭合压(P0.1),浅快呼吸指数(RSBI)等,并进行膈肌M型超声与组织多普勒超声检查,筛选撤机失败的影响因素,运用ROC曲线下面积评价各撤机指标预测机械通气患者撤机结局的准确性。结果:两组间一般临床指标比较,RSBI和呼吸机使用时间在撤机成功组均明显低于撤机失败组间(均P<0.05)。与撤机成功组相比,撤机失败组患者膈肌收缩期峰值运动速度(PCV)、膈肌舒张期峰值运动速度(PRV)、膈肌舒张期运动加速度(MRR)、膈肌收缩平均速度(DSVm)值更高,而膈肌移动度(DE)更低(均P<0.05)。多因素Logistic分析显示,PRV(OR=1.611,95%CI:1.068,2.431)、MRR(OR=1.332,95%CI:1.017,1.746)升高及DE(OR=0.378,95%CI:1.210,5.784)减小为机械通气撤机失败的独立危险因素,PRV、MRR、DE联合预测(AUC=0.871)机械通气患者撤机失败的准确性高于单一指标。结论:组织多普勒成像技术可评估机械通气患者膈肌功能,联合M型超声综合评估膈肌功能对撤机结局有较好的预测价值。

Objective:To assess diaphragm function by tissue doppler imaging on mechanically ventilated patients,and to evaluate the predictive value of this technique in the outcome of withdrawal.Methods:A total of 115 patients with invasive mechanical ventilation in the intensive care unit of Yichang Central People's Hospital from January 2022 to December 2022 were included in this study.According to the evacuation outcome,they were divided into the successful evacuation group of 85 cases and the failed evacuation group of 30 cases.All patients underwent and passed the spontaneous breathing test(SBT)before withdrawal.Ventilatory parameters at the time of withdrawal were recorded,including respiratory rate(RR),maximum inspiratory pressure(MIP),inspiratory oral closure pressure at 0.1 s(P0.1),rapid shallow breathing index(RSBI).M-mode diaphragm ultrasonography and tissue doppler ultrasonography were performed.The influencing factors of withdrawal failure were screened,and the area under ROC curve was used to evaluate the accuracy of each withdrawal index in predicting the outcome of patients using mechanical ventilation.Results:Compared with the general clinical indexes between the two groups,RSBI and ventilator use time in the successful group were significantly lower than those in the failed group(P<0.05).Compared with the successful withdrawal group,the values of peak contraction velocity(PCV),peak relaxation velocity(PRV),maximal relaxation rate(MRR)and mean systolic velocity of diaphragm(DSVm)in the failed withdrawal group were higher,while the degree of diaphragm excursion(DE)was lower(all P<0.05).Multivariate logistic analysis showed that the increase of PRV(OR=1.611,95%CI:1.068,2.431)and MRR(OR=1.332,95%CI:1.017,1.746),as well as the decrease of DE(OR=0.378,95%CI:1.210,5.784)were independent risk factors for mechanical ventilation withdrawal failure.The accuracy of PRV,MRR and DE combined in predicting(AUC=0.871)mechanical ventilation withdrawal failure was higher than that of single index.Conclusion:Tissue doppler imaging can evaluate the diaphragm function of patients with mechanical ventilation,and the combined assessment of diaphragm function with M-mode ultrasound has a good predictive value for the outcome of withdrawal.