| 龙玲,赵浩天,任珊,何聪,赵鹤龄.超声监测膈肌厚度吸气变化率对机械通气患者拔管结局评价[J].中国医学影像技术,2020,36(4): |
| 超声监测膈肌厚度吸气变化率对机械通气患者拔管结局评价 |
| Ultrasound monitoring of diaphragm thickness fraction in evaluating extubation outcome in patients undergoing mechanical ventilation |
| 投稿时间：2019-04-18 修订日期：2020-04-22 |
| DOI： |
| 中文关键词: 膈肌超声 膈肌增厚率 机械通气 撤机 浅快呼吸指数 |
| 英文关键词:diaphragmatic ultrasound diaphragm thickening fraction mechanical ventilation weaning rapid shallow breathing index |
| 基金项目:河北省科技计划项目（152777137）；政府资助临床医学优秀人才培养和基础课题研究项目（361003）；河北省医学科学研究重点课题计划（20160083） |
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| 中文摘要: |
| [摘 要] 目的：评估膈肌厚度随吸气变化率对机械通气（MV）患者撤机结果的评估和预测价值。方法：选取入住我院重症医学科（ICU）行MV＞48小时且准备撤机的患者，SBT期间使用床旁超声测量并计算患者膈肌增厚率(DTF)、膈肌增厚浅快呼吸指数(DTF-RSBI)，并同时记录浅快呼吸指数(RSBI)及其他生理指标。采用受试者工作特征曲线(ROC)评价DTF和DTF-RSBI对撤机成败的预测价值。结果：共54例患者纳入本研究，其中撤机成功36例，撤机失败18例，成功组患者DTF明显高于失败组，但RBSI及DTF-RBSI明显低于失败组(P＜0.05)。DTF取28.5%为截断值，预测撤机ROC曲线下面积为0.702，灵敏度和特异度分别为78.8%和61.1%，DTF-RBSI 取72.6次/(min·mm)截断值预测撤机ROC曲线下面积为0.903，敏感度和特异度分别为100.0%和72.2%。结论：膈肌增厚浅快呼吸指数在预测撤机结果方面比DTF及传统的RSBI更准确，具有较强的实用价值。 |
| 英文摘要: |
| Objective: To evaluate the predictive value of diaphragmatic ultrasound for the outcomes of ventilator weaning in patients with mechanical ventilation. Methods: Patients were ventilated mechanically for more than 48 hours and ready to be weaned when they admitted to ICU of Hebei General Hospital from December 2016 to December 2017 were enrolled. During the T-tube spontaneous breathing trial, the diaphragm thickening fraction (DTF) and diaphragm thickening rapid shallow breathing index (DTF-RSBI) were measured and calculated by bedside ultrasound. Rapid shallow breathing index (RSBI) and other physiological fingers were recorded. Receiver operator characteristic curve (ROC) was used to evaluate the predictive value of DTF and DTF-RSBI for weaning. Results: A total of 54 patients were enrolled in this study. Among them, 36 were successful in weaning and 18 failed in weaning. DTF in successful group was significantly higher than that in failure group, but RBSI and DTF-RBSI were significantly lower than those in failure group (P < 0.05). When the cut-off value of DTF was 28.5%, the areas under the ROC curves for DTF is 0.702, sensitivity and specificity are 78.8% and 61.1% respectively. When the cut-off value of DTF-RSBI was 72.6 breaths/(min·mm), AUC for DTF-RSBI is 0.903, sensitivity and specificity are 100.0% and 72.2% respectively. Conclusion: DTF-RSBI is more accurate than DTF and traditional RSBI for predicting outcomes of weaning predicting weaning outcomes and has a strong practical value. |
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