不同心脏超声指标对ICU呼吸衰竭机械通气撤机结局的预测价值

Prognostic value of different cardiac ultrasound indexes for weaning outcome of mechanical ventilation of respiratory failure in ICU

目的比较不同心脏超声指标对ICU呼吸衰竭机械通气撤机结局的预测价值。方法连续选取解放军第九二一医院重症医学科2020年10月至2023年3月期间因呼吸衰竭接受机械通气>48h拟撤机患者,记录患者一般资料、机械通气情况、撤机时相关检验指标,并用超声测量左室射血分数(LVEF)、左室流出道时间速度积分(VTI)、左心Tei指数(TI)及二尖瓣瓣血流速度峰值和二尖瓣环侧壁及室间隔舒张早期运动峰值速度比值(E/e')。根据撤机结局进行分组,绘制不同心脏超声指标对撤机结局的受试者工作特征(ROC)曲线,评估其对撤机结局的预测价值。结果共纳入83例患者,62例撤机成功,21例撤机失败。撤机成功组机械通气时间、呼吸浅快指数、LVEF、VTI、左心TI、E/e'与撤机失败组比较差异有统计学意义(均P<0.05)。多因素回归分析提示机械通气时间及E/e'是呼吸衰竭患者撤机结局的独立影响因素(0R=0.603,0.282,均P<0.05)。E/e'预测机械通气撤机失败的ROC曲线下面积为0.844(95%CI:0.729~0.959),优于呼吸浅快指数及其他心脏超声指标。结论心脏超声对呼吸衰竭机械通气撤机结局有预测价值,反映心脏舒张功能的E/e'预测效能最大,但均不适合单指标预测。

Objective To compare the predictive value of different cardiac ultrasound indexes in mechanical ventilation withdrawal/weaning outcome of intensive care unit(ICU)respiratory failure.Methods Patients who received mechanical ventilation for>48 hours and were to be withdrawn due to respiratory failure in the Department of Critical Care Medicine,921st Hospital of the People's Liberation Army from October 2020 to March 2023 were continuously selected,and their general information,mechanical ventilation conditions,and relevant weaning inspection indicators were recorded.Left ventricular ejection fraction(LVEF),left ventricular outlow tract velocity time integral(LVOT-VTI),left heart Tei index(TI),ratio of early mitral valve diastolic peak blood flow velocity to early mitral ring diastolic peak motion velocity(E/e')were measured by ultrasound.According to the weaning outcome,the receiver operating characteristic(ROC)curves of different cardiac ultrasound indexes were plotted to evaluate the predictive value of the withdrawal outcome.Results A total of 83 patients were included,of which 62 were successfully withdrawn and 21 were unsuccessful.There were significant differences in mechanical ventilation time,rapid shallow breathing index(RSBI),LVEF,VTI,left cardiac TI and E/e'between the successful group and the failed group(all P<0.05).Multivariate regression analysis suggested that mechanical ventilation time and E/e'were independent factors affecting the outcome of patients with respiratory failure(OR=0.603,0.282,all P<0.05).The area under ROC curve of E/e'predicting mechanical ventilation withdrawal/weaning failure was 0.844(95%Cl:0.729-0.959),which was superior to the RSBI and other cardiac ultrasound indexes.Conclusions Echocardiography has predictive value for the outcome of mechanical ventilation of respiratory failure,and E/e',which reflects the diastolic function of the heart,is the most effective predictor,but it is not suitable for single index prediction.