膈肌位移联合下腔静脉变异度对机械通气患者撤机结局的预测价值

Predictive value of diaphragm displacement combined with ultrasound monitoring of inferior vena cava variability in predicting weaning outcome in patients with mechanical ventilation

目的探讨膈肌位移(DD)联合下腔静脉变异度(△DVCV)对机械通气(MV)患者撤机结局的预测价值。方法回顾性分析2021年1月至2022年1月于乐平市天湖医院进行MV的80例患者的临床资料。收集所有患者的临床资料,并应用超声检查评估患者△DVCV和DD,同时记录患者呼吸浅快指数(RBSI),根据撤机结果分为撤机成功组与撤机失败组。比较两组的临床资料、撤机参数,采用ROC分析DD、△DVCV对MV撤机结局的预测价值。结果80例患者中,50例撤机成功,30例撤机失败;两组性别、年龄、急性生理学和慢性健康状况评价Ⅱ(APACHEⅡ)、MV时长、氧合指数、pH值比较差异无统计学意义。撤机成功组RBSI小于撤机失败组,△DVCV大于撤机失败组,DD长于撤机失败组,差异有统计学意义(P<0.05)。ROC曲线结果分析显示,△DVCV、DD单独预测MV患者撤机结局的AUC均高于RBSI,且DD联合△DVCV对MV撤机结局的灵敏度、特异度、准确度均高于△DVCV、DD单独预测。结论DD联合△DVCV对MV患者撤机结局的预测价值较高,可为撤机提供更加全面、准确的数据支持,从而提升预测价值。

Objective To investigate the predictive value of diaphragm displacement(DD)combined with inferior vena cava(△DVCV)for weaning outcome in patients with mechanical ventilation(MV).Methods The clinical data of 80 patients who underwent Leping Tianhu Hospital from January 2021 to January 2022 were retrospectively analyzed.The clinical data of all patients were collected,and the in-ferior vena cava variability and DD were evaluated by ultrasonography,and the rapid shallow breathing index(RBSI)was recorded,the patients were divided into the successful weaning group and the failure weaning group according to the results of weaning.The clinical data and weaning parame-ters of the two groups were compared,ROC was used to analyze the predictive value of DD and△DVCV on the weaning outcome of mechanical ventilation.Results Among the 80 patients,50 cases were successfully weaned and 30 cases were failed.There were no significant differences in gender,age,Acute physiology and chronic health evaluationⅡ(APACHEⅡ),duration of MV,oxygenation index and pH value between the two groups.The RBSI in the successful weaning group was smaller than that of the failed weaning group,the△DVCV was larger than that in the failed weaning group,and the DD was longer than that in the failed weaning group,the differences were statistically significant(P<0.05).ROC curve anal-ysis showed that the AUC of△DVCV and DD alone in predicting the weaning outcome of MV patients was higher than that of RBSI,and the sensi-tivity,specificity and accuracy of DD combined with△DVCV in predicting the weaning outcome of MV were higher than those of△DVCV and DD alone.Conclusion DD combined with△DVCV has the high predictive value for weaning outcome of MV patients,which can provide more comprehensive and accurate data support for weaning,thus improving the predictive value.