超声量化膈肌收缩速度在判断机械通气撤机中的价值

目的:探讨超声检测膈肌收缩速度判断机械通气患者撤机成功的价值。方法:2016年7月至2019年2月,以复旦大学附属中山医院急诊ICU的94例有创机械通气的患者为研究对象,其中急性呼吸窘迫综合征患者61例,心肺复苏术后患者33例。94例患者分为撤机成功组(n=73)和撤机失败组(n=21)。自主呼吸试验第0 min、5 min、30 min用超声检查膈肌,根据膈肌位移和吸气时间计算膈肌收缩速度。用ROC曲线法通过膈肌收缩速度预测撤机成功的价值。结果:撤机失败组膈肌功能障碍19例,占90.48%,撤机成功组膈肌功能障碍41例,占56.16%,组间差异有统计学意义(P0.05)。随着自主呼吸试验时间延长,撤机成功组和撤机失败组的膈肌收缩速度均有所升高(P0.05)。撤机成功组在自主呼吸第5 min和30 min时膈肌收缩速度均低于撤机失败组,组间差异有统计学意义(P0.05)。自主呼吸第0 min和5 min时,膈肌收缩速度预测撤机成功的AUC分别为0.469和0.501。第30 min时预测价值最高,AUC为0.791,灵敏度和特异度分别达75.32%、69.37%(P0.05)。结论:采用超声检测膈肌功能较为简便,自主呼吸试验第30 min时,以膈肌收缩速度≤1.57 cm/s为临界值时预测撤机成功的价值较高。

The value of ultrasound detection of diaphragm contraction velocity in predicting mechanical ventilation withdrawal

Objective: To investigate the value of ultrasound detection of diaphragm contraction velocity in predicting mechanical ventilation withdrawal. Methods: From July 2016 to February 2019, 94 patients requiring mechanical ventilation in the Emergency Department of Zhongshan Hospital in Shanghai were studied, including 61 patients with acute respiratory distress syndrome and 33 patients after cardiopulmonary resuscitation. The 94 patients were divided into successful weaning group (n=73) and failure weaning group (n=21). The diaphragm was examined by ultrasound at 0 min, 5 min, and 30 min of spontaneous breathing test. The diaphragm contraction velocity was calculated according to the diaphragm displacement and inspiration time. The receiver operating characteristic (ROC) curve was plotted to predict the diaphragm contraction velocity and predict the value of successful weaning. Results: Diaphragmatic dysfunction was found in 19 patients (90.48%) in the failure group and 41 patients (56.16%) in the successful weaning group. There was a significant difference between the two groups (P<0.05). With the prolongation of spontaneous breathing test time, the diaphragm contraction speed of successful weaning group and failure weaning group increased (P<0.05). The diaphragm contraction speed of successful weaning group was lower than that of failure weaning group at 5 and 30 minutes of spontaneous breathing (P<0.05). At 0 min and 5 min of spontaneous breathing, the area under the curve (AUC) predicting successful weaning was 0.469 and 0.501, respectively. The predictive value was the highest at 30 min, and the AUC was 0.791, sensitivity and specificity were 75.32% and 69.37%, respectively (P<0.05). Conclusions: Ultrasound is a simple method to detect diaphragm function. When the diaphragm contraction velocity is less than 1.57 cm/s at 30 minutes of spontaneous breathing test, it is of high value to predict successful weaning.