血清白蛋白和膈肌移动度与二次插管的相互关系

目的:研究重症医学科机械通气患者拔管前白蛋白、膈肌移动度与二次插管的相关性。方法:采用前瞻性研究方法，选取天津医科大学第二医院重症医学科2017年6月—2018年3月收治的31例使用机械通气治疗的患者作为研究对象，根据脱机结果，分为一次成功脱机组（25例）和二次插管组（6例），在患者准备脱机时行自主呼吸试验（SBT），期间测定患者的膈肌移动度及血清白蛋白水平。采用Pearson相关法分析拔管前白蛋白与膈肌移动度的相关性；采用单因素分析法分析拔管前白蛋白与二次插管的相关性，膈肌移动度与二次插管的相关性。采用中介作用方法，探究膈肌移动度能否作为白蛋白和脱机结果的中介作用。结果:拔管前白蛋白水平与膈肌移动度呈正相关（r=0.036，P<0.05)；拔管前白蛋白水平与二次插管呈负相关（B=-0.512，P<0.05)；膈肌移动度与二次插管呈负相关（B=-0.380，P<0.05）。膈肌移动度不是白蛋白水平与脱机结果的中介作用（Z=-1.43，P>0.05)。结论:接受机械通气治疗的患者，拔管前白蛋白、膈肌移动度与二次插管三者之间两两相关。但是白蛋白不是通过膈肌作用来影响脱机结果的。

Relationship between serum albumin and diaphragmatic mobility and secondary intubation

Objective: To study correlation between albumin before extubation，diaphragmatic displacement and secondary intubation in patients with mechanical ventilation in intensive care department. Methods: From June 2017 to March 2018 in the Department of Intensive Care Medicine of the Second Hospital of Tianjin Medical University，a prospective study was conducted on 31 patients treated with mechanical ventilation. According to the ventilator weaning results，the patients were divided into two groups:one-time successful detaching group （25 cases）and two-time intubation group（6 cases）. Spontaneous breathing test（SBT）was performed when the patient was ready to go offline，during which the diaphragmatic muscle mobility and serum albumin values were measured. Pearson correlation method was used to analyze the correlation between albumin before extubation and diaphragmatic displacement. Using single factor analysis，the correlation between albumin before extubation and secondary intubation was analyzed. And the correlation between diaphragmatic displacement and secondary intubation was analyzed. Using the mediating method，the mediating effect of the diaphragm on albumin and weaning results was analyzed. Results: The correlation between albumin before extubation and diaphragmatic muscle mobility was statistically significant（r=0.036，P<0.05）. The correlation between albumin before extubation and secondary intubation was statistically significant（B=-0.512，P<0.05）. The correlation between diaphragmatic muscle mobility and secondary intubation was statistically significant（B=-0.380，P<0.05）. Diaphragmatic muscle mobility was not the mediating effect of albumin and weaning results（Z=-1.43，P>0.05）. Conclusion: There are pairwise correlations between pre-extubation albumin，diaphragmatic mobility and secondary intubation in patients receiving mechanical ventilation. However，albumin does not affect weaning results through diaphragmatic action.