Objective To systematically assess diaphragm dysfunction in patients with sepsis.Based on previous findings that diaphragm excursion and diaphragm thickening fraction(DTF)significantly decrease in septic patients,this...Objective To systematically assess diaphragm dysfunction in patients with sepsis.Based on previous findings that diaphragm excursion and diaphragm thickening fraction(DTF)significantly decrease in septic patients,this study further analyzed the diaphragm contraction velocity and excursion-time index(E-T index)in relation to diaphragm contraction time.Methods A total of 59 patients with pneumonia-induced sepsis fromShengjingg Hospital of ChinaNMedical University were recruited(sepsis group).Healthy individuals undergoing routine health check-ups during the same period were recruited as the control group,matched for age and sex(1:1).General baseline data were collected,and bedside ultrasound was used to measure diaphragm thickness,DTF,diaphragm excursion,inspiratory time,diaphragm E-T index,and per-minute E-T index(calculated as the quiet breathing diaphragm E-T index muliplied by the respiratory rate).Correlation analyses were performed between diaphragm ultrasound indicators and the Sequential Organ Failure Assessment(SOFA)score.SPSS 21.0 was used for statistical analysis.Results(1)There was no statistically significant difference in diaphragm thickness between the sepsis group and the control group(end of quiet expiratory:(2.06±0.35)mm vs.(1.96±0.37)mm,t=-1.516,P>0.05;end of maximum inspiratory:3.18(2.86,3.61)mm us.3.04(2.73,3.27)mm,Z=-1.688,P>0.05),while DTF was significantly lower in the sepsis group compared to the control group(0.49±0.17 vs.0.65±0.17,t=5.360,P<0.05).(2)In both quiet breathing and deep breathing states,diaphragm excursion was lower in the sepsis group than in the control group(quiet breathing:t=-4.187,P<0.05;deep breathing:t=-11.720,P<0.05),and inspiratory time was shorter in the sepsis group(quiet breathing:t=-7.410,P<0.05;deep breathing:t=-6.348,P<0.05).(3)In the quiet breathing state,the diaphragm contraction velocity in the sepsis group was faster than in the control group(Z=2.330,P<0.05),while in the deep breathing state,the diaphragm contraction velocity in the sepsis group was lower than in the control group(Z=-3.383,P<0.05).(4)In the quiet breathing state,the diaphragm E-T index was lower in the sepsis group than in the control group(Z=-5.762,P<0.05);however,the per-minute E-T indexcompensatedtonormalby increasing the respiratory rate.In the deep breathinggstate,the diaphragm E-T index,which had the highest correlation with the SOFA score(r=-0.882,P<0.05),was lower in the sepsis group than in the control group(Z=-7.974,P<0.05).Conclusion Bedside ultrasound can systematically quantify diaphragmn contraction dysfunction in patients with sepsis.In the quiet breathing state,septic patients exhibit a pattern of shallow and rapid breathing,allowing the body to compensate for oxygen demand.In the deep breathing state,the intrinsic contraction efficiency and functional capacity of the diaphragm in septic patients decrease and the diaphragm is unable to meet the body's oxygen requirements due to decompensation.展开更多
文摘Objective To systematically assess diaphragm dysfunction in patients with sepsis.Based on previous findings that diaphragm excursion and diaphragm thickening fraction(DTF)significantly decrease in septic patients,this study further analyzed the diaphragm contraction velocity and excursion-time index(E-T index)in relation to diaphragm contraction time.Methods A total of 59 patients with pneumonia-induced sepsis fromShengjingg Hospital of ChinaNMedical University were recruited(sepsis group).Healthy individuals undergoing routine health check-ups during the same period were recruited as the control group,matched for age and sex(1:1).General baseline data were collected,and bedside ultrasound was used to measure diaphragm thickness,DTF,diaphragm excursion,inspiratory time,diaphragm E-T index,and per-minute E-T index(calculated as the quiet breathing diaphragm E-T index muliplied by the respiratory rate).Correlation analyses were performed between diaphragm ultrasound indicators and the Sequential Organ Failure Assessment(SOFA)score.SPSS 21.0 was used for statistical analysis.Results(1)There was no statistically significant difference in diaphragm thickness between the sepsis group and the control group(end of quiet expiratory:(2.06±0.35)mm vs.(1.96±0.37)mm,t=-1.516,P>0.05;end of maximum inspiratory:3.18(2.86,3.61)mm us.3.04(2.73,3.27)mm,Z=-1.688,P>0.05),while DTF was significantly lower in the sepsis group compared to the control group(0.49±0.17 vs.0.65±0.17,t=5.360,P<0.05).(2)In both quiet breathing and deep breathing states,diaphragm excursion was lower in the sepsis group than in the control group(quiet breathing:t=-4.187,P<0.05;deep breathing:t=-11.720,P<0.05),and inspiratory time was shorter in the sepsis group(quiet breathing:t=-7.410,P<0.05;deep breathing:t=-6.348,P<0.05).(3)In the quiet breathing state,the diaphragm contraction velocity in the sepsis group was faster than in the control group(Z=2.330,P<0.05),while in the deep breathing state,the diaphragm contraction velocity in the sepsis group was lower than in the control group(Z=-3.383,P<0.05).(4)In the quiet breathing state,the diaphragm E-T index was lower in the sepsis group than in the control group(Z=-5.762,P<0.05);however,the per-minute E-T indexcompensatedtonormalby increasing the respiratory rate.In the deep breathinggstate,the diaphragm E-T index,which had the highest correlation with the SOFA score(r=-0.882,P<0.05),was lower in the sepsis group than in the control group(Z=-7.974,P<0.05).Conclusion Bedside ultrasound can systematically quantify diaphragmn contraction dysfunction in patients with sepsis.In the quiet breathing state,septic patients exhibit a pattern of shallow and rapid breathing,allowing the body to compensate for oxygen demand.In the deep breathing state,the intrinsic contraction efficiency and functional capacity of the diaphragm in septic patients decrease and the diaphragm is unable to meet the body's oxygen requirements due to decompensation.
