| 赵浩天,王晓娜,刘元琳,燕亚茹,刘奕,李丽.基于组织多普勒成像校正膈肌超声参数评估无创机械通气呼吸困难患者膈肌功能[J].中国医学影像技术,2024,40(10):1567~1571 |
| 基于组织多普勒成像校正膈肌超声参数评估无创机械通气呼吸困难患者膈肌功能 |
| Tissue Doppler imaging corrected diaphragm ultrasonic parameters for evaluating diaphragmatic function in dyspnea patients underwent non-invasive mechanical ventilation |
| 投稿时间：2024-04-23 修订日期：2024-06-16 |
| DOI：10.13929/j.issn.1003-3289.2024.10.023 |
| 中文关键词: 呼吸困难 呼吸,人工 膈 超声检查 |
| 英文关键词:dyspnea respiration,artificial diaphragm ultrasonography |
| 基金项目:河北省医学科学研究课题计划项目(20211264、20200774)。 |
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| 中文摘要: |
| 目的 观察组织多普勒成像(TDI)校正膈肌超声参数用于评估无创机械通气呼吸困难患者膈肌功能的价值。方法 前瞻性对31例因突发呼吸困难而接受无创机械通气＜1 h患者(无创通气组)及31名健康体检者(对照组)行膈肌超声检查,测算膈肌移动度(DD)、呼气末期膈肌厚度(DTee)、吸气末期膈肌厚度(DTei)及膈肌增厚率(DTF),并以TDI模式测量膈肌收缩期(DPSV)及舒张期峰值速度(DPDV);计算以浅快呼吸指数(RSBI)校正后的DD及DTF(DD-RSBI、DTF-RSBI),根据DPSV及DPDV与呼吸频率乘积获得DPSV-RSBI及DPDV-RSBI,以DPSV及DPDV校正DD及DTF,获得膈肌收缩期(DD/DPSV及DTF/DPSV)及舒张期(DD/DPDV及DTF/DPDV)代偿做功指数。对上述超声参数进行组间比较;绘制受试者工作特征曲线,计算曲线下面积(AUC),分析各参数评估无创机械通气呼吸困难患者膈肌功能的效能。结果 无创通气组DPSV、DPDV、DD-RSBI、DTF-RSBI、DPSV-RSBI及DPDV-RSBI均高于,而DD/DPSV、DD/DPDV、DTF/DPSV及DTF/DPDV均低于对照组(P均＜0.05);组间DD、DTee、DTei及DTF差异均无统计学意义(P均＞0.05)。DPSV-RSBI及DPDV-RSBI用于评估无创通气呼吸困难患者膈肌功能效能优异(AUC=0.974、0.919),DPSV、DD-RSBI、DTF-RSBI、DD/DPSV及DTF/DPSV效能尚好(AUC为0.760~0.881),而DD、DPDV、DTee、DTei、DTF、DD/DPDV及DTF/DPDV效能差或一般(AUC为0.467~0.698)。结论 TDI校正膈肌超声参数可有效评估无创通气呼吸困难患者膈肌功能。 |
| 英文摘要: |
| Objective To explore the value of tissue Doppler imaging (TDI) corrected diaphragm ultrasonic parameters for evaluating diaphragmatic function in dyspnea patients who underwent non-invasive mechanical ventilation. Methods Thirty-one acute dyspnea patients who underwent non-invasive mechanical ventilation less than 1 h (non-invasive ventilation group) and 31 healthy subjects (control group) were prospectively enrolled, and ultrasound of diaphragm was performed. Routine diaphragmatic parameters, including diaphragm displacement (DD), diaphragm thickness of end-expiratory (DTee), diaphragm thickness of end-inspiratory (DTei) and diaphragm thickening fraction (DTF) were measured and calculated, while peak systolic velocity of diaphragm (DPSV) and peak diastolic velocity of diaphragm (DPDV) were measured using TDI mode. Based on DD and DTF after rapid shallow breathing index (RSBI), DD-RSBI and DTF-RSBI were corrected, DPSV-RSBI and DPDV-RSBI were obtained by calculating product of DPSV and DPDV with respiratory rate, respectively. The index of compensatory work of diaphragm during systole (DD/DPSV and DTF/DPSV ) and diastole (DD/DPDV and DTF/DPDV) were obtained by corrected DD and DTF with DPSV and DPDV, respectively. The ultrasonic parameters of diaphragm were compared between groups. Receiver operating characteristic (ROC) curve was drawn, and the area under the curve (AUC) was calculated to evaluate the efficacy of ultrasonic parameters of diaphragm for assessing diaphragmatic function in dyspnea patients who underwent non-invasive mechanical ventilation. Results DPSV, DPDV, DD-RSBI, DTF-RSBI, DPSV-RSBI and DPDV-RSBI in non-invasive ventilation group were all higher, while DD/DPSV, DD/DPDV, DTF/DPSV and DTF/DPDV were all lower than those in control group (all P＜0.05). No significant difference of DD, DTee, DTei nor DTF was found between groups (all P＞0.05). DPSV-RSBI and DPDV-RSBI had excellent efficacy for assessing diaphragmatic function in dyspnea patients after non-invasive mechanical ventilation (AUC=0.974, 0.919), DPSV, DD-RSBI, DTF-RSBI, DD/DPSV and DTF/DPSV had good efficacy (AUC 0.760—0.881), while DD, DPDV, DTee, DTei, DTF, DD/DPDV and DTF/DPDV had bad or general efficacy (AUC 0.467—0.698). Conclusion TDI corrected diaphragm ultrasonic parameters could effectively evaluate diaphragmatic function in dyspnea patients who underwent non-invasive mechanical ventilation. |
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