摘要
目的:评估肺部超声、膈肌超声在预测创伤危重症患者呼吸机撤机成功中的价值。方法:前瞻性分析2020年8月-2021年12月惠州市惠阳区妇幼保健院收治的92例满足自主呼吸试验(SBT)的创伤急危重症患者,根据SBT能否顺利撤机分为成功组和失败组,收集入组患者的一般临床资料,SBT开始15 min后开始床旁超声检查肺、膈肌功能。记录肺部超声评分(LUS)、膈肌活动度(DE)和膈肌移动时间(E-T)指数。将单变量分析中有统计学差异的参数纳入多变量logistic回归分析中,寻找独立预测参数。并用受试者工作特征曲线(ROC曲线)比较独立预测参数的敏感度及特异度。结果:成功组55例,失败组37例。SBT期间,失败组的呼吸频率,心率,LUS评分均高于成功组,膈肌活动度,吸气时间,E-T指数均低于成功组(P<0.05)。多因素分析结果显示,LUS评分[OR=2.752,95%CI(1.928,3.575)]、膈肌活动度[OR=4.329,95%CI(3.309,5.342)]和E-T指数[OR=3.103,95%CI(1.496,4.711)]均是预测撤机失败的预测因素(P<0.001)。ROC分析结果显示LUS评分的AUC为0.692,最佳截断值为9.50分,敏感度和特异度分别为0.72和0.51。膈肌活动度的AUC为0.861,最佳截断值为13.00 mm,敏感度和特异度分别为0.80和0.82。E-T指数的AUC为0.794,最佳截断值为1.91,敏感度和特异度分别为0.76和0.79。联合检测的AUC高达0.932,敏感度和特异度分别为0.93和0.90。结论:SBT期间,较低的LUS评分,较高的膈肌活动度,较大的E-T指数均预示着患者撤机成功。三种指标的联合检测可以更好地预测患者撤机成功。
Objective:To evaluate the value of pulmonary ultrasound and diaphragmatic ultrasound in predicting the successful ventilator weaning of patients with critically traumatic ill patients.Method:A prospective analysis of 92 patients with severe traumatic who met the spontaneous breathing test(SBT)admitted to Huizhou Huiyang Maternal and Child Health Hospital from August 2020 to December 2021 was divided into successful and failed groups according to whether they were weaning.The general clinical data of the patients were collected,and the lung and diaphragm function were examined by bedside ultrasound 15 minutes after the start of SBT.Lung ultrasound score(LUS),diaphragmatic activity(DE),and diaphragmatic movement time(E-T)index were recorded and patient vital signs were monitored in real time.The statistically significant parameters in the univariate analysis were included in the multivariate logistic regression analysis to find independent prediction parameters.The receiver operating characteristic curve(ROC)was used to compare the sensitivity and specificity of the independent prediction parameters.Result:There were 55 cases in the successful group and 37 cases in the failed group.During SBT,the respiratory rate,heart rate and LUS score of the failed group were higher than those of the successful group,while the diaphragmatic activity,inspiratory time and E-T index of the failed group were lower than those of the successful group(P<0.05).Multivariate analysis showed that LUS score[OR=2.752,95%CI(1.928,3.575)],diaphragmatic activity[OR=4.329,95%CI(3.309,5.342)]and E-T index[OR=3.103,95%CI(1.496,4.711)]were predictors of offline failure(P<0.001).ROC analysis results showed that the AUC of LUS score was 0.692,the optimal cut-off value was 9.50 points,and the sensitivity and specificity were 0.72 and 0.51,respectively.The AUC of diaphragm activity was 0.861,the optimal cut-off value was 13.00 mm,and the sensitivity and specificity were 0.80 and 0.82,respectively.The AUC of E-T index was 0.794,the optimal cut-off value was 1.91,and the sensitivity and specificity were 0.76 and 0.79,respectively.The AUC was up to 0.932,and the sensitivity and specificity were 0.93 and 0.90,respectively.Conclusion:During SBT,a lower LUS score,a higher diaphragmatic activity,and a larger E-T index indicate a successful weaning outcome.The combined detection of three indicators can better predict the success of patients weaning.
作者
胡日洋
HU Riyang(Huizhou Huiyang Maternal and Child Health Hospital,Guangdong Province,Huizhou 516000,China)
出处
《中国医学创新》
CAS
2023年第16期51-56,共6页
Medical Innovation of China
关键词
膈肌超声
肺部超声评分
机械通气
Diaphragmatic ultrasound
Lung ultrasound scoring
Mechanical ventilation
