| 陆敏姣,潘慧斌,邹涛.COPD机械通气患者撤机指导中床旁超声膈肌功能评估的应用及其临床价值研究[J].浙江中西医结合杂志,2021,31(2): |
| COPD机械通气患者撤机指导中床旁超声膈肌功能评估的应用及其临床价值研究 |
| Application and clinical value of mid-bedside ultrasound in evaluating the function of diaphragm in patients with COPD mechanical ventilationLu minjiao,Pan huibin,Zou tao |
| 投稿时间：2020-04-19 修订日期：2020-10-03 |
| DOI： |
| 中文关键词: 机械通气 撤机指导 床旁超声 膈肌功能评估 临床价值 慢性阻塞性肺疾病 |
| 英文关键词:Mechanical ventilation Withdrawal instruction Bedside ultrasound Diaphragm function evaluation Clinical value Chronic obstructive pulmonary disease |
| 基金项目:浙江省医药卫生科技计划项目(No.2019KY679) |
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| 中文摘要: |
| 【摘要】目的 探讨COPD机械通气患者撤机指导中床旁超声膈肌功能评估的应用及其临床价值。方法 选取2018年9月-2019年12月入住我院重症特护病房需进行机械通气的慢性阻塞性肺疾病患者120例，按照撤机成功与否分为两组，将撤机失败设为对照组（n=74），将撤机成功设为研究组（n=46），对两组患者不同时间段在自主呼吸实验（SBT）中右侧膈肌位移（DE）变化情况、SBT中DE对撤机的预测价值、SBT中膈肌收缩速度以及SBT中膈肌收缩速度对撤机的预测价值进行分析研究。结果 两组患者在初始期间时DE变化无明显差异（P＞0.05），5分钟后对照组明显低于研究组（P＜0.05）；DE对撤机成功的准确度和灵敏度在SBT中的表现均十分显著，DE的AUC最佳临界值为0.862，处于SBT30min时，临界值为DE＞1.15cm，对撤机成功的准确度、灵敏度和特异度进行预测分别为95.58%、99.99%、92.35%。SBT中两组患者的膈肌收缩速度均呈上升趋势，两组患者在初始期间收缩速度无明显差异（P＞0.05），研究组患者在5min后其收缩速度显著低于对照组（P＜0.05）；撤机成功准确度和灵敏度与SBT中膈肌收缩速度呈相关性，当DE预测撤机成功的AUC值为0.746时SBT为30分钟，膈肌收缩速度的临界值在1.47cm/s及以下时，对撤机成功的准确度、灵敏度和特异度进行预测为66.24%、68.44%、62.24%。结论 超声膈肌功能评估可有效地对慢性阻塞性肺疾病患者进行撤机指导，且在机械通气患者撤机指导中具有显著的预测价值，且预测结果较为准确，对撤机成功率进行有效改善，当临界值DE＞1.15cm时，膈肌收缩速度的临界值在1.47cm/s及以下时，预测较为准确，也可联合其他指标进行应用。
【关键词】机械通气；撤机指导；床旁超声；膈肌功能评估；临床价值；慢性阻塞性肺疾病 |
| 英文摘要: |
| [abstract] objective to explore the application and clinical value of mid-bedside ultrasound in evaluating the function of diaphragm in patients with COPD mechanical ventilation. Selection methods in January 2018 - March 2019 at our hospital intensive intensive care unit require mechanical ventilation of 120 patients with chronic obstructive pulmonary disease, according to the ventilator success is divided into two groups, will withdraw machine failure set as the control group (n = 74), will withdraw machine successfully set to the team (n = 46), different time periods in the spontaneous breathing in patients with two groups of experiments (SBT) on the right side of the diaphragm displacement changes (DE), DE value for the forecast of ventilator in SBT, SBT diaphragmatic muscle contraction speed and diaphragmatic muscle contraction in the SBT predictive value of ventilator. Results during the initial period, there was no significant difference in DE between the two groups (P > 0.05). The optimal critical value of the AUC of DE is 0.862,At SBT 30min, the critical value is DE > 1.15cm. The accuracy, sensitivity and specificity of successful withdrawal are predicted to be 95.58%, 99.99% and 92.35%, respectively. In SBT, the phrenic contraction speed of the two groups showed an increasing trend. There was no significant difference in the initial contraction speed between the two groups (P > 0.05). The contraction speed of the study group was significantly lower than that of the control group after 5min (P < 0.05). The accuracy and sensitivity of successful withdrawal were correlated with the contraction speed of the diaphragm in SBT. When the AUC value of DE predicting successful withdrawal was 0.746, SBT was 30 minutes. When the critical value of diaphragm contraction speed was 1.47cm/s or below, the accuracy, sensitivity and specificity of successful withdrawal were predicted to be 66.24%, 68.44% and 62.24%. Conclusion ultrasonic diaphragm function assessment can be effectively removed from machine guidance to patients with chronic obstructive pulmonary disease, and in patients with mechanical ventilation withdraw machine instruction has significant predictive value, and the prediction results more accurate, effectively improve the success rate of ventilator, when threshold DE > 1.15 cm, the critical value of diaphragmatic muscle contraction speed at 1.47 cm/s and under, forecasting more accurate, also can be joint application with other indicators.
【 key words 】 Mechanical ventilation; Withdrawal instruction; Bedside ultrasound; Diaphragm function evaluation; Clinical value; Chronic obstructive pulmonary disease |
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