老年机械通气患者膈肌浅快呼吸指数与肺部超声评分的相关性及其对撤机结局的预测价值

Correlation between diaphragmatic-rapid shallow breathing index and lung ultrasound score in elderly patients with mechanical ventilation and its predictive value for weaning results

目的探讨老年机械通气患者膈肌浅快呼吸指数(D-RSBI)与肺部超声评分(LUS)的相关性及其对撤机结局的预测价值。方法收集2021年1月至2022年6月在锦州医科大学附属第一医院重症监护病房(ICU)接受治疗的老年(年龄>60岁)有创正压通气(IPPV)患者的临床资料进行回顾性研究。根据撤机结局将患者分为成功组和失败组,比较两组患者性别、年龄、急性生理学与慢性健康状况评分Ⅱ(APACHEⅡ)以及撤机拔管前D-RSBI和LUS等指标的差异;采用Pearson相关性分析D-RSBI与LUS评分的相关性;采用受试者工作特征曲线(ROC曲线)分析D-RSBI和LUS评分对老年IPPV患者撤机结局的预测价值。结果共纳入398例老年IPPV患者,其中撤机成功300例,失败98例。失败组与成功组性别、年龄差异均无统计学意义〔男性:55.1%(54/98)比59.0%(177/300),年龄(岁):67.02±5.03比66.96±4.99,均P>0.05〕,失败组APACHEⅡ评分明显高于成功组(分:17.09±3.30比16.06±3.81,P<0.05),撤机拔管前D-RSBI和LUS评分均明显高于成功组〔D-RSBI(次·min-1·mm-1):2.19±0.33比1.60±0.22,LUS(分):17.30±3.04比11.97±3.20,均P<0.01〕。所有患者D-RSBI与LUS评分呈显著正相关(r=0.406,P=0.000)。ROC曲线分析显示,D-RSBI预测老年IPPV患者撤机结局的曲线下面积(AUC)为0.920,95%可信区间(95%CI)为0.881~0.958,P=0.000,当截断值为1.85次·min-1·mm-1时敏感度为88.7%,特异度为86.7%;LUS评分预测老年IPPV患者撤机结局的AUC为0.875,95%CI为0.839~0.912,P=0.000,当截断值为14.50分时敏感度为75.7%,特异度为84.7%。结论老年机械通气患者D-RSBI与LUS评分有显著相关性,二者均可以预测老年机械通气患者的撤机结局。

Objective To investigate the correlation between diaphragmatic-rapid shallow breathing index(D-RSBI)and lung ultrasound score(LUS)in elderly patients with mechanical ventilation and its predictive value for weaning results.Methods A retrospective study was conducted.The clinical data of elderly patients(age>60 years old)with invasive positive pressure ventilation(IPPV)admitted to the department of intensive care unit(ICU)of the First Affiliated Hospital of Jinzhou Medical University from January 2021 to June 2022 were enrolled.According to the outcome of withdrawal,the patients were divided into successful and failed groups.The differences in gender,age,acute physiology and chronic health evaluationⅡ(APACHEⅡ),D-RSBI and LUS before weaning and extubation were compared between the two groups.Pearson correlation was used to analyze the correlation between D-RSBI and LUS.The predictive value of D-RSBI and LUS on weaning results of elderly patients with IPPV was analyzed by receiver operator characteristic curve(ROC curve).Results A total of 398 elderly patients with IPPV were enrolled,including 300 successful weaning patients and 98 failed weaning patients.There were no significant differences in gender and age between the failed group and successful group[male:55.1%(54/98)vs.59.0%(177/300),age(years old):67.02±5.03 vs.66.96±4.99,both P>0.05].APACHEⅡscore in the failed group was significantly higher than that in the successful group(17.09±3.30 vs.16.06±3.81,P<0.05),and the D-RSBI and LUS score before extubation were significantly higher than those in the successful group[D-RSBI(time·min-1·mm-1):2.19±0.33 vs.1.60±0.22,LUS:17.30±3.04 vs.11.97±3.20,both P<0.01].All patients showed a significant positive correlation between D-RSBI and LUS score(r=0.406,P=0.000).ROC curve analysis showed that the area under the curve(AUC)of D-RSBI for predicting weaning outcomes in elderly IPPV patients was 0.920,with a 95%confidence interval(95%CI)of 0.881-0.958 and P=0.000.When the cut-off value was 1.85 times·min-1·mm-1,the sensitivity was 88.7%and the specificity was 86.7%.The AUC of LUS score for predicting weaning outcome in elderly IPPV patients was 0.875,with a 95%CI of 0.839-0.912 and P=0.000.When the cut-off value was 14.50,the sensitivity was 75.7%and the specificity was 84.7%.Conclusion There is a significant correlation between D-RSBI and LUS score in elderly mechanically ventilated patients,both of them can predict weaning outcome in elderly patients with mechanical ventilation.