超声评估膈肌功能联合肌力和病情严重程度评分预测重症肺炎患者机械通气撤机结局

Ultrasound assessment of diaphragm function combined with scores of muscle strength and illness severity for predicting weaning outcome in severe pneumonia patients after mechanical ventilation

目的观察超声评估膈肌功能联合英国医学研究理事会(MRC)肌力评分及急性生理学与慢性健康状况Ⅱ(APACHEⅡ)评分预测重症肺炎患者机械通气撤机结局的价值。方法回顾性收集102例接受机械通气治疗的重症肺炎患者,均于自主呼吸试验(SBT)前、后以超声测量膈肌移动度及收缩速度评估膈肌功能后撤机;根据撤机结果分为撤机成功(成功组,n=76)与撤机失败(失败组,n=26)。以单因素分析及多因素logistic回归分析临床资料、SBT前MRC肌力和APACHEⅡ评分,以及SBT前、后膈肌功能参数,筛选撤机失败独立危险因素并建立联合回归模型;以受试者工作特征曲线及曲线下面积(AUC)评估单一独立危险因素及联合回归模型的诊断效能。结果SBT前MRC和APACHEⅡ评分、膈肌移动度和膈肌收缩速度均为重症肺炎患者机械通气撤机失败的独立危险因素(P均<0.05),其AUC分别为0.682、0.667、0.785及0.685;联合回归模型的AUC为0.898,高于单一独立危险因素(P均<0.05)。结论以超声评估膈肌功能联合MRC肌力及APACHEⅡ评分可有效预测重症肺炎患者机械通气撤机结局。

Objective To observe the value of ultrasound assessment of diaphragm function combined with the Medical Research Council(MRC)muscle strength score and acute physiology and chronic healthⅡ(APACHEⅡ)score for predicting weaning outcome in severe pneumonia patients after mechanical ventilation.Methods Totally 102 patients with severe pneumonia who underwent mechanical ventilation were retrospectively enrolled.Spontaneous breathing trial(SBT)was performed,and diaphragmatic mobility and contraction velocity were measured before and after SBT to evaluate diaphragm function.All patients were divided into successful weaning(successful group,n=76)and failed weaning group(failure group,n=26)according to breathing condition after weaning.Univariate analysis and multivariate logistic regression were used to analyze clinical data,MRC and APACHEⅡscores before SBT,as well as diaphragm function parameters before and after SBT,and the independent risk factors for weaning failure were screened,based which a combined regression model was established.The diagnostic efficacy of each independent risk factor and combined regression model was evaluated by receiver operating characteristic curve and the area under the curve(AUC).Results MRC and APACHEⅡscores,diaphragmatic mobility and contraction velocity before SBT were all independent risk factors for weaning failure in severe pneumonia patients after mechanical ventilation(all P<0.05),with AUC of 0.682,0.667,0.785 and 0.685,respectively.The AUC of combined regression model established with the above independent risk factors was 0.898,higher than that of each independent risk factor(all P<0.05).Conclusion Ultrasound assessment of diaphragm function combined with MRC muscle strength and APACHEⅡscores could effectively predict weaning outcome in severe pneumonia patients who underwent mechanical ventilation.