膈肌超声参数对ICU呼吸机依赖患者预后及生活质量的评估效果

Evaluation effect of diaphragmatic ultrasound parameters on the prognosis and quality of life of ICU ventilator-dependent patients

目的 探究膈肌超声参数对重症监护室(ICU)呼吸机依赖患者预后及生活质量的评估效果。方法 回顾性选取于2019年1月至2022年12月青岛市中医医院ICU收治的125例呼吸机依赖患者作为研究对象,根据患者预后情况分为预后良好组(成功脱机,自主呼吸时间>48 h,n=85)与预后不良组(n=40)。采用超声诊断系统检测患者膈肌超声参数[膈肌增厚分数(DTF)、呼气末膈肌厚度(DTee)、吸气末膈肌厚度(DTei)、膈肌活动度(DE)],评估患者急性生理学和慢性健康状况评价Ⅱ(APACHEⅡ)评分、圣乔治呼吸问卷(SGRO)评分。比较两组患者膈肌超声参数及各评分;采用多因素Logistci回归分析法分析呼吸机依赖患者预后的影响因素;采用Spearman法分析DTF、DTee、DTei、DE与APACHEⅡ评分、SGRO评分的相关性。结果 预后良好组DTee、DTei、DTF、DE分别为(2.34±0.53) mm、(2.93±0.41) mm、(24.28±3.45)%、(11.34±2.24) mm,均高于预后不良组[(1.53±0.51) mm、(2.24±0.41) mm、(19.43±3.27)%、(8.93±1.96) mm],差异均有统计学意义(P<0.05)。预后良好组APACHEⅡ评分、SGRO评分分别为(8.42±1.23)、(32.28±3.56)分,均低于对照组[(15.03±1.42)、(51.29±4.22)分],差异均有统计学意义(P<0.05)。多因素Logistci回归分析显示,DTee、DTei、DTF、DE、APACHEⅡ评分、SGRO评分均为ICU呼吸机依赖患者预后的独立影响因素(P<0.05)。相关性分析显示,DTee、DTei、DTF、DE与APACHEⅡ评分呈负相关(r=-0.683、-0.723、-0.791、-0.852,P<0.05),与SGRO评分呈负相关(r=-0.676、-0.715、-0.802、-0.762,P<0.05)。结论 膈肌超声参数能够评估ICU呼吸机依赖患者的预后情况,且与患者生活质量密切相关,应予以高度重视。

Objective To explore the evaluation effect of diaphragmatic ultrasound parameters on the prognosis and quality of life of ventilator-dependent patients in the intensive care unit(ICU).Methods A retrospective selection of 125 ventilator dependent patients admitted to the ICU of Qingdao Hospital of Traditional Chinese Medicine from January 2019 to December 2022 was retrospectively conducted.According to the patient's prognosis,they were divided into the good prognosis group(successfully taken offline,spontaneous breathing time>48 hours,n=85) and the poor prognosis group(n=40).The diaphragmatic ultrasound parameters [diaphragmatic thickening fraction(DTF),end expiratory diaphragmatic thickness(DTee),end inspiratory diaphragmatic thickness(DTei),and diaphragmatic excursion(DE)] of the patients were detected using the ultrasound diagnostic system,and the patient's acute physiology and chronic health status evaluation Ⅱ(APACHE Ⅱ) score and St George's respiratory questionnaire(SGRO) score were evaluated.The differences in diaphragm ultrasound parameters and scores between two groups were compared,the prognostic factors of ventilator-dependent patients were analyzed using multiple Logistic regression analysis,and the correlation between DTF,DTee,DTei,DE,APACHE Ⅱscore,and SGRO score were analyzed using Spearman's method.Results The DTee,DTei,DTF,and DE of the good prognosis group were(2.34±0.53) mm,(2.93±0.41) mm,(24.28±3.45)%,and(11.34±2.24) mm,respectively,which were higher than those of the poor prognosis group [(1.53±0.51) mm,(2.24±0.41) mm,(19.43±3.27)%,and(8.93±1.96) mm],and the differences were statistically significant(P<0.05).The APACHE Ⅱ score and SGRO score of the good prognosis group were(8.42±1.23),(32.28±3.56) points,respectively,which were lower than those of the poor prognosis group[(15.03±1.42),(51.29±4.22) points],and the differences were statistically significant(P<0.05).Multivariate Logistic regression analysis showed that DTee,DTei,DTF,DE,APACHE Ⅱscore,and SGRO score were all independent prognostic factors for ICU ventilator-dependent patients(P<0.05).Correlation analysis showed that DTee,DTei,DTF,DE were negatively correlated with APACHE Ⅱscore(r=-0.683,-0.723,-0.791,-0.852;P<0.05),and negatively correlated with SGRO score(r=-0.676,-0.715,-0.802,-0.762;P<0.05).Conclusion Diaphragm ultrasound parameters can evaluate the prognosis of ICU ventilator-dependent patients and are closely related to their quality of life,which should be highly valued.