摘要
目的:探讨膈肌和外周骨骼肌超声回声特征的变化以及与脓毒症机械通气患者通气结局和预后的关系,以探索肌肉超声在指导脓毒症患者早期精准评估中的潜在价值。方法:选取2023年1月—2024年12月入住南通大学附属医院重症医学科(Intensive Care Unit,ICU)的脓毒症机械通气患者为研究对象,连续观察并分析患者入ICU时、入ICU 48 h和出ICU时的膈肌和股四头肌超声图像,计算膈肌回声强度(echogenicity of diaphragm,EDi)/股直肌回声强度(echogenicity of rectus femoris,ERF)比值(EDi/ERF)、膈肌厚度(thickness of diaphragm,Tdi)/股四头肌厚度(quadriceps muscle layer thickness,Q-MT)比值(Tdi/Q-MT)。根据患者EDi/ERF、Tdi/Q-MT变化趋势,将患者分为比值增高组及比值降低组。分别比较两组患者的脱机成功率、机械通气时间、住院时间、28 d生存率等,以评价膈肌与外周骨骼肌的超声特征变化对脓毒症机械通气患者临床结局的指导价值。结果:共有110例患者纳入研究,EDi/ERF比值增高组患者的脱机成功率显著低于EDi/ERF比值降低组(P=0.043),机械通气时间显著长于EDi/ERF比值降低组(P=0.019),28 d生存率显著低于EDi/ERF比值降低组(P=0.008);Tdi/Q-MT比值增高组与Tdi/Q-MT比值降低组在脱机成功率、机械通气时间、28 d生存率方面差异均无统计学意义(P > 0.05)。Cox比例风险模型分析结果表明,EDi增强及EDi/ERF比值增加是影响患者28 d累积脱机成功率的重要危险因素(HR=0.306,P=0.045;HR=0.287,P=0.031)。结论:脓毒症机械通气患者早期出现膈肌回声强度增高、膈肌与外周骨骼肌回声强度比值增高均与更低的脱机成功率和更差的临床预后有关。
Objective:To investigate the relationship between changes in ultrasound echo characteristics of the diaphragm and peripheral skeletal muscles and weaning outcome and prognosis in mechanically ventilated patients with sepsis,in order to explore the potential value of muscle ultrasound in guiding the early and accurate assessment of patients with sepsis.Methods:Mechanically ventilated septic patients admitted to the Department of Critical Care Medicine of Affiliated Hospital of Nantong University from January 2023 to December 2024 were selected as the study subjects,and the ultrasound images of diaphragm and quadriceps femoris were consecutively observed and analyzed at the time of admission to the ICU,48h,and discharge from the ICU.The echogenicity of diaphragm(EDi)/echogenicity of rectus femoris(ERF)ratio(EDi/ERF)and the thickness of diaphragm(Tdi)/quadriceps muscle layer thickness(Q-MT)ratio(Tdi/Q-MT)were calculated.According to the trend of EDi/ERF and Tdi/Q-MT,the patients were categorized into the group with increasing ratio and the group with decreasing ratio.The weaning success rate,duration of mechanical ventilation,length of stay,and 28-day survival rate of the two groups were compared separately to evaluate the guiding value of changes in the ultrasound characteristics of the diaphragm and peripheral skeletal muscles on the clinical outcome of mechanically ventilated patients with sepsis.Results:A total of 110 patients were enrolled in the study,and the patients in the group with increased EDi/ERF ratio had a significantly lower weaning success rate(P=0.043),a significantly longer mechanical ventilation time(P=0.019),and a significantly lower 28-day survival rate(P=O.008)than those in the group with decreased EDi/ERF ratio.No statistically significant differences in weaning success rate,duration of mechanical ventilation,and 28-day survival rate were found between the group with increased Tdi/QMT ratio and decreased Tdi/Q-MT ratio(P>O.05).The Cox proportional hazards model showed that enhanced EDi and increased EDi/ERF ratio were significant risk factors affecting the 28-day cumulative weaning success rate(HR=0.306,P=0.045;HR=0.287,P=0.031,respectively).Conclusion:The early presence of increased echogenicity of diaphragm and increased diaphragm to peripheral skeletal muscle echogenicity ratio are both associated with lower weaning success rate and poorer clinical prognosis in mechanically ventilated patients with sepsis.
作者
孙晨靓
王帆
余磊
黄俐珍
赵宏胜
郭凤梅
沈浩亮
SUN Chenliang;WANG Fan;YU Lei;HUANG Lizhen;ZHAO Hongsheng;GUO Fengmei;SHEN Haoliang(Department of Critical Care Medicine,Affiliated Hospital of Nantong University,Nantong 226001;Medical School of Nantong University,Nantong 226001;Department of Critical Care Medicine,Hongdu Traditional Chinese Medicine Hospital Affiliated to Jiangxi University of Chinese Medicine,Nanchang 330006;Department of Critical Care Medicine,Zhongda Hospital Southeast University,Nanjing 210009,China)
出处
《南京医科大学学报(自然科学版)》
北大核心
2026年第2期231-240,共10页
Journal of Nanjing Medical University(Natural Sciences)
基金
南通市卫生健康委员会科研课题基金(MS2024015)。
关键词
脓毒症
机械通气
肌肉超声
超声回声强度
脱机
临床结局
sepsis
mechanical ventilation
muscle ultrasound
echogenicity
weaning
clinical outcome
