超声监测膈肌功能对急性胰腺炎病人早期病情评估的作用

Role of ultrasonographic monitoring of diaphragmatic functionin early assessment of patients with acute pancreatitis

目的:探讨超声监测膈肌功能(膈肌增厚分数及膈肌移动度)对急性胰腺炎(AP)病人早期病情评估的作用。方法:选取急诊外科收治的AP病人作为研究对象,根据病情轻重分为重症急性胰腺炎(SAP)组(40例)和非重症急性胰腺炎(N-SAP)组(55例)。比较入院时2组病人一般资料、吸气末膈肌厚度(DTei)、呼气末膈肌厚度(DTee)、膈肌增厚分数(DTF)、平静呼吸移动度及深呼吸移动度,采用Pearson相关分析DTF与APACHEⅡ评分、Ranson评分、改良CT严重指数(MCTSI)的相关性;ROC曲线分析DTF对AP病情的评估价值。结果:入院后,2组年龄、性别、DTei及DTee比较差异均无统计学意义(P>0.05);SAP组病人的APACHEⅡ评分、Ranson评分及MCTSI较N-SAP组明显增加(P<0.01);SAP组DTF、平静呼吸移动度及深呼吸移动度小于N-SAP组(P<0.05);DTF与APACHEⅡ评分、Ranson评分及MCTSI均呈负相关关系(r=-0.503、-0.557、r=-0.557,P<0.01);DTF的ROC曲线下面积为0.799。结论:超声监测膈肌功能(DTF及膈肌移动度)对AP病人早期病情评估具有指导价值。

Objective:To explore the role of ultrasound monitoring of diaphragmatic function(fraction of diaphragmatic thickening and diaphragmatic mobility)in early assessment of patients with acute pancreatitis(AP).Methods:The AP patients from the emergency were divided into the severe AP(SAP)group(40 cases)and N-SAP group(55 cases)according to the severity of illness.The general data,DTei,DTee,DTF,calm breathing mobility and deep breathing mobility were compared between two groups at admission.The Pearson correlation analysis was used to analyze the correlations between DTF and APACHEⅡscore,Ranson score,MCTSI,and the receiver operating characteristic(ROC)curve was used to was used to evaluate the value of DTF in AP disease.Results:After admission,there was no statistical significance in the age,gender,DTei and DTee between two groups(P>0.05).The APACHEⅡscore,Ranson score and MCTSI in the SAP group were significantly higher than those in the N-SAP group(P<0.01).The DTF,calm breathing mobility and deep breathing mobility in the SAP group were lower than those in the N-SAP group(P<0.05).The DTF was negatively correlated with the APACHEⅡscore,Ranson score and MCTSI(r=-0.503,r=-0.557,r=-0.557,P<0.01),and the area under ROC curve of DTF was 0.799.Conclusions:The role of ultrasonic monitoring of diaphragm function(DTF and diaphragm mobility)in the early assessment of AP patients has guiding value for the early assessment of AP disease.