重症超声监测膈肌位移预测ICU机械通气患者撤机能力的价值

杨华萍 刘江 刘淋 余国宝 王波 贺兴华 董莉

[摘要]目的 探討重症超声监测膈肌位移对重症加强护理病房（ICU）机械通气患者撤机能力的预测价值。方法 回顾性分析我院2018年5月～2019年12月收治的100例呼吸衰竭患者的临床资料，根据撤机情况分为撤机成功组（77例）与撤机失败组（23例），使用超声仪器测量患者膈肌位移情况，受试者工作特征（ROC）曲线评价膈肌位移对ICU机械通气患者撤机能力的预测价值。结果 撤机失败组0.1 s气道闭合压（P0.1）、浅快呼吸指数（RSBI）高于撤机成功组，左侧膈肌位移、右侧膈肌位移、平均膈肌位移低于撤机成功组，差异均有统计学意义（P<0.05）;经ROC曲线分析，P0.1所得ROC曲线下面积（AUC）为0.831，最佳截断值为2.50 cmH2O时，敏感度为0.739，特异度为0.299;RSBI所得AUC为0.839，最佳截断值为45.40时，敏感度为0.783，特异度为0.208;左侧膈肌位移所得AUC为0.904，最佳截断值为0.77 cm时，敏感度为0.870，特异度为0.234;右侧膈肌位移所得AUC为0.901，最佳截断值为1.12 cm时，敏感度为0.826，特异度为0.208;平均膈肌位移所得AUC为0.909，最佳截断值为1.00 cm时，敏感度为0.913，特异度为0.494。结论 重症超声监测膈肌位移在预测ICU机械通气患者撤机能力中具有较高的应用价值。

[关键词]重症加强护理病房;呼吸衰竭;床旁超声;膈肌位移;撤机能力

[中图分类号] R441          [文献标识码] A          [文章编号] 1674-4721（2020）7（b）-0037-03

The value of severe ultrasound monitoring of excursion of diaphragm in prediction of weaning ability in patients with mechanical ventilation in ICU

YANG Hua-ping   LIU Jiang   LIU Lin   YU Guo-bao   WANG Bo   HE Xing-hua   DONG Li

Department of Critical Care， General Hospital of Pingxiang Mining Group Co.， Ltd.， Jiangxi Province， Pingxiang   337000， China

[Abstract] Objective To investigate the value of severe ultrasound monitoring of excursion of diaphragm in prediction of weaning ability in patients with mechanical ventilation in intensive care unit （ICU）. Methods The clinical data of 100 patients with respiratory failure who admitted to our hospital from May 2018 to December 2019 were retrospectively analyzed， and they were divided into successful withdrawal group （77 cases） and failed withdrawal group （23 cases）according to withdrawal situation. The excursion of diaphragm of patients was measured by ultrasound instruments， and the ROC curve was used to evaluate the predictive value of excursion of diaphragm in weaning ability of patients with mechanical ventilation in ICU. Results The 0.1 s airway occlusion pressure （P0.1） and rapid-shallow-breathing index （RSBI） in failed withdrawal group group were higher than those in successful withdrawal group， and the left excursion of diaphragm， right excursion of diaphragm and mean excursion of diaphragm in failed withdrawal group group were lower than those in successful withdrawal group（P<0.05）; After analysis of the ROC curve， the area under the ROC curve （AUC） obtained by P0.1 was 0.831， when the optimal cutoff value was 2.50 cmH2O， the sensitivity was 0.739 and the specificity was 0.299. The AUC obtained by RSBI was 0.839， when the optimal cutoff value was 45.40， the sensitivity was 0.783 and the specificity was 0.208. The AUC obtained by left excursion of diaphragm was 0.904， when the optimal cutoff value was 0.77 cm， the sensitivity was 0.870 and the specificity was 0.234. The AUC obtained by right excursion of diaphragm was 0.901， when the optimal cutoff value was 1.12 cm， the sensitivity was 0.826 and the specificity was 0.208. The AUC obtained by mean excursion of diaphragm was 0.909， when the optimal cutoff value was 1.00 cm， the sensitivity was 0.913 and the specificity was 0.494. Conclusion Severe ultrasound monitoring of excursion of diaphragm has higher application value in prediction of weaning ability in patients with mechanical ventilation in ICU.

[Key words] Intensive care unit; Respiratory failure; Bedside ultrasound; Excursion of diaphragm; Weaning ability

[基金项目]江西省卫生健康委科技计划项目（20204474）

[作者简介]杨华萍（1982-），男，江西萍乡人，本科，主治医师，研究方向：急危重症病的抢救治疗

重症加强护理病房（ICU）的患者因各种基础疾病导致呼吸衰竭，需行机械通气治疗[1-2]。机械通气治疗可维持气道通畅，防止机体缺氧，为治疗基础疾病提供有利条件，目前广泛应用于临床治疗中，但部分患者无法从通气支持转为自主呼吸状态，出现撤机困难的情况，增加患者病死风险[3]。0.1 s气道闭合压（P0.1）、最大吸气压（MIP）、浅快呼吸指数（RSBI）等是目前常用的撤机参数，但不足以准确预测撤机时机，而撤机时机不当可导致撤机失败[4]。临床发现，部分ICU患者因通气时间较长或身体条件较差出现膈肌功能障碍，增加撤机失败率，若早期发现膈肌功能障碍，可能为撤机成功提供帮助[5]。……