膈肌超声功能跨膈压及超声心输出量与AECOPD机械通气患者撤机结局的相关性分析

Correlation of ultrasonic function of diaphragm,transdiaphragmatic pressure and ultrasonic cardiac output with weaning outcome in patients with AECOPD undergoing mechanical ventilation

目的探讨膈肌超声功能、跨膈压及超声心输出量(CO)与慢性阻塞性肺疾病急性加重(AECOPD)机械通气患者撤机结局的相关性。方法回顾性选取92例AECOPD患者为研究对象。所有患者均接受机械通气治疗,并行自主呼吸试验(SBT)。分析比较撤机成功和失败患者临床资料、膈肌超声评估、跨膈压等指标;分析比较治疗后28 d死亡和存活患者临床资料。AECOPD患者机械通气撤机成功与否的影响因素采用Logistic回归分析。采用受试者工作特征(ROC)曲线分析膈肌超声评估、跨膈压及超声CO相关指标在撤机失败中的预测价值。结果撤机失败患者年龄、急性生理与慢性健康评估Ⅱ评分均高于撤机成功患者(P<0.01);撤机失败患者SBT前最大跨膈压、膈肌移动度(DE)、膈肌增厚率(DTF)、CO和心脏指数(CI)均低于撤机成功患者(P<0.01)。APACHEⅡ评分、最大跨膈压、DE、DTF和CO是AECOPD机械通气患者撤机失败的影响因素(P<0.01),五项指标联合预测患者撤机失败的曲线下面积为0.857(P<0.01)。死亡患者APACHEⅡ评分高于存活患者(P<0.01)。结论APACHEⅡ评分、最大跨膈压、DE、DTF和CO是AECOPD机械通气患者撤机失败的影响因素,五项参数对撤机结局均具有较好的预测价值,联合预测更有利于撤机结局的评估。

Objective To investigate the correlation of ultrasonic assessment of diaphragm,transdiaphragmatic pressure(TDP),and ultrasonic cardiac output and the outcome of weaning outcome in patients with acute exacerbation of chronic obstructive pulmonary disease(AECOPD)undergoing mechanical ventilation.Methods Ninety-two AECOPDA patients were retrospectively selected as study subjects.All patients received mechanical ventilation and underwent spontaneous breathing tests(SBT).The clinical data,diaphragm ultrasound evaluation,and transdiaphragmatic pressure were analyzed and compared between patients who successfully and unsuccessfully weaned from mechanical ventilation;clinical data of patients who died and survived after 28 day treatment were analyzed and compared.Logistic regression analysis was used to analyze the factors influencing the weaning success or failure from mechanical ventilation in patients with AECOPD.Receiver operating characteristic(ROC)curve analysis was used to analyze the predictive value of diaphragm ultrasound evaluation,transdiaphragmatic pressure,and ultrasonic cardiac output-related indicators in weaning failu refrom mechanical ventilation.Results The age and score on Acute Physiology and Chronic Health EvaluationⅡ(APACHEⅡ)were higher in patients with weaning failure than ones with success(P<0.01);the maximum TDP,diaphragmatic excursion(DE),diaphragmatic thickening fraction(DTF),cardiac output(CO),and cardiac index(CI)before the SBT were lower in patients with weaning failure than ones with success(P<0.01);APACHE Ⅱ score,maximum TDP,DE,DTF,and CO were the inf luencing factors of weaning failure in AECOPD patients undergoing mechanical ventilation(P<0.01),the area under the ROC curve of 5 index combination predicting weaning failure was 0.857(P<0.01);APACHE II score was higher in deceased patients than surviving ones(P<0.01).Conclusion APACHE Ⅱ score,maximum TDP,DE,DTF,and CO are the influencing factors of weaning failure in AECOPD mechanically ventilated patients,five parameters have good predictive value for weaning outcomes,and combined prediction is more conducive to evaluating weaning outcomes.