膈肌超声检测在预测A型主动脉夹层患者术后机械通气脱机结局中的应用

Ultrasonographic diaphragm parameters in predicting outcomes of postoperative mechanical ventilation weaning in patients with type A aortic dissection

目的探讨膈肌超声相关参数检测预测A型主动脉夹层患者术后机械通气脱机结局的应用价值。方法回顾性选取2022年11月至2023年12月温州医科大学附属第一医院心脏重症监护室收治的A型主动脉夹层术后机械通气时间≥48 h的患者101例,患者脱机前均行膈肌超声检测评估膈肌运动幅度(DE)和膈肌增厚分数(DTF)。其中77例患者脱机后48 h内无需再次使用无创或有创机械通气,为脱机成功组,24例患者未通过自主呼吸筛查试验,或脱机后死亡,或脱机后48 h内再次需要无创或有创机械通气支持,为脱机失败组。比较两组患者左右两侧DE和DTF;分析左右两侧DE和DTF对脱机失败的预测效能。结果脱机成功组患者左侧DE、右侧DE、左侧DTF、右侧DTF均大于脱机失败组(均P<0.05)。ROC曲线分析显示,左、右侧DE预测脱机成功的最佳截断值分别为9.50、11.05 mm,灵敏度分别为0.917和0.833,特异度分别为0.753和0.883。左、右侧DTF预测脱机成功的最佳截断值分别为20.60%和19.75%,灵敏度分别为0.750和0.667,特异度分别为0.766、0.870。结论超声测量膈肌的定量参数可较为准确地预测A型主动脉夹层患者术后机械通气的脱机结局,具有较好的临床应用价值,值得推广。

Objective To explore the predictive value of diaphragmatic ultrasound parameters in assessing the outcome of weaning from mechanical ventilation in patients with type A aortic dissection.Methods Clinical data of 101 patients who underwent mechanical ventilation for≥48 h after type A aortic dissection surgery in Cardiac Intensive Care Unit(CICU)of the First Affiliated Hospital of Wenzhou Medical University from November 2022 to December 2023 were retrospectively analyzed.Before weaning,all patients underwent diaphragmatic ultrasonography to assess diaphragm excursion(DE)and diaphragm thickening fraction(DTF).Among them,77 patients did not require reinstitution of noninvasive or invasive mechanical ventilation within 48 h after weaning(successful weaning group);and 24 patients either failed the spontaneous breathing trial(SBT)and died after weaning,or required reinstitution of noninvasive or invasive mechanical ventilation within 48 h after weaning(weaning failure group).The DE and DTF on both the left and right sides were compared between the two groups,the predictive efficacy of left and right DE and DTF for weaning failure was assessed.Results In the successful weaning group,the DE on the left side and right side,DTF on the left side and right side were significantly higher than those in the weaning failure group(all P<0.05).ROC curve analysis revealed that the optimal cutoff values for predicting successful weaning of left and right DE were 9.50 mm and 11.05 mm,with sensitivity of 0.917 and 0.833 and specificity of 0.753 and 0.883,respectively.The optimal cutoff values for predicting successful weaning of left and right DTF were 20.60%and 19.75%,with sensitivity of 0.750 and 0.667 and specificity of 0.766 and 0.870,respectively.Conclusion Quantitative parameters measured by ultrasonography of the diaphragm can predict the outcome of weaning from mechanical ventilation in patients with type A aortic dissection after surgery with relatively high accuracy,which is worth promoting in clinical application.