床旁多脏器联合超声在重症患者机械通气脱机风险评估中的应用价值

目的探讨床旁多脏器超声在重症患者机械通气脱机风险评估中的应用价值。 方法选取2016年3月至2017年9月于杭州市第一人民医院及杭州市老年病医院重症医学科进行机械通气治疗、且已达到临床脱机标准的患者72例。所有患者均行床旁多脏器联合超声检查。心脏超声评估心脏大小结构及心功能指标，肺部超声探查双侧胸腔及肺脏，了解肺部情况并进行评分，膈肌超声检查测量膈肌的活动度、厚度及增厚率。对患者的超声检查结果、脱机失败病因及随访预后情况进行分析。 结果72例机械通气患者中，脱机成功46例，脱机失败26例。脱机成功组与脱机失败组比较，2组间左室射血分数（LVEF）、二尖瓣口充盈血流频谱E峰与二尖瓣环组织多普勒e峰比值（E/e′）、主动脉瓣口速度时间积分（AOVTI）、肺动脉收缩压、肺部评分、膈肌增厚率及膈肌活动度差异均有统计学意义（t/Z=0.65、0.63、-4.05、2.03、8.32、11.06、3.58，P均<0.05）。应用多脏器联合超声对脱机失败患者进行随访观察，其中3例膈肌功能障碍患者，通过康复训练，膈肌活动度及增厚率明显提高；3例肺动脉高压患者进行肺动脉压力及肺部超声随访，其中1例动脉导管封堵术后第2天成功脱机。 讨论床旁多脏器联合超声可在患者治疗期间进行实时监测和随访，为机械通气患者脱机的风险评估提供参考依据，具有重要的临床应用价值。

Application value of bedside multi-organ ultrasound in risk assessment of weaning from mechanical ventilation in critically ill patients

ObjectiveTo evaluate the value of bedside multi-organ ultrasonography in the risk assessment of weaning from mechanical ventilation in critically ill patients. MethodsA total of 72 inpatients who had received mechanical ventilation treatment and reached the clinical weaning standard in the intensive care unit of Hangzhou First People's Hospital and Hangzhou Geriatric Hospital from March 2016 to September 2017 were selected. All patients underwent bedside multi-organ ultrasonography before and after weaning. Cardiac ultrasonography was used to evaluate the indexes of cardiac structure and function. Pulmonary ultrasonography was used to detect bilateral thoracic cavity and lungs to evaluate and score the pulmonary condition. Phrenic ultrasonography was used to measure the motion amplitude, thickness, and thickening rate of the diaphragm. The results of ultrasound examination, reasons of weaning failure, and follow-up prognosis were analyzed. ResultsAmong the 72 cases with mechanical ventilation, forty six were successfully weaned from ventilation and 26 failed. Compared with the control group, the differences of left ventricular ejection fraction (LVEF), ratio of early diastolic mitral flow velocity to early diastolic mitral annulus velocity (E/e′), aortic valve velocity time integral (AOVTI), pulmonary artery systolic pressure, lung score, and the motion amplitude, thickness, and thickening rate of the diaphragm between the two groups were statistically significant (t/Z=0.65, 0.63, -4.05, 2.03, 8.32, 11.06, and 3.58, respectively; P<0.05 for all). Bedside multi-organ ultrasound was used to follow and observe the 26 patients who failed to be weaned from ventilation. Among them, three patients with diaphragmatic dysfunction showed obvious improvement in diaphragm motion amplitude and thickening rate through rehabilitation training. Pulmonary arterial pressure and pulmonary ultrasound were monitored in three patients with pulmonary arterial hypertension, and one patient was successfully weaned from ventilation 2 days after patent ductus arteriosus occlusion. ConclusionBedside multi-organ ultrasound can be used for real-time monitoring and follow-up of patients with mechanical ventilation, thus providing a tool for the risk assessment of weaning from mechanical ventilation.