| 摘要: |
| 目的 建立膈肌超声评分表,探讨膈肌超声评分表对机械通气患者撤机成功与否的预测价值。方法 观察2016年10月- 2018年10月收住黄河三门峡医院EICU的64例机械通气的患者,通气时间时间大于48h,并且达到自主呼吸试验(SBT)［1］标准。临床医师床旁进行超声检查记录患者SBT时膈肌厚度的变化,双侧膈肌的运动幅度,同时记录潮气量以及呼吸频率。根据患者脱机成功与否分为成功组和失败组。通过绘制ROC受试者工作曲线,分析SBT时膈肌厚度变化,膈肌运动幅度,膈肌相关的浅快呼吸指数(D-RSBI)对脱机失败发生的最佳预测值和临界值,并根据最佳临界值将相关的连续性变量转化为二分类变量,进行多因素Logistic回归分析,根据其OR值的大小,对独立危险因素进行赋值,建立评分表。通过评分表预测患者脱机成功的概率。结果 膈肌超声评分表将撤机失败患者的风险划分为三个层次：低危组(0-2分)、中危组(3-6分)和高危组(7-8分),其中低危组撤机失败发生率约为12.5%,中危组撤机失败发生率约为53.7%,高危组撤机失败发生率约为84.8%。结论 膈肌超声评分表能够预见性的评估机械通气患者脱机的风险。 |
| 关键词: 膈肌 超声 脱机 隔肌功能障碍 机械通气 |
| DOI： |
| 投稿时间：2019-06-19修订日期：2019-07-11 |
| 基金项目: |
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| The value of diaphragm ultrasonic rating scale in predicting mechanical ventilator withdrawal LIU Jinyu,WANG Qiang,WANG Xiaomi,GONG Decheng,ZHANG Lei.Yellow River Sanmenxia hospital,Sanmenxia 472000,China |
| Liujinyu |
| () |
| Abstract: |
| 【】ObjectiveTo establish the phrenic ultrasonic rating scale and explore the predictive value of the phrenic ultrasonic rating scale for the success of mechanical ventilation patients. MethodsThe 64 cases of mechanical ventilation patients admitted to EICU in sanmenxia hospital of the Yellow River from October 2016 to October 2018 were observed. The duration of ventilation was longer than 48h, and the patients reached the standard of spontaneous breathing test (SBT) [1]. Bedside ultrasound was performed by the clinician to record the changes in the thickness of the diaphragm during SBT, the range of motion of bilateral diaphragms, and tidal volume and respiratory frequency. Patients were divided into success group and failure group according to their offline success or failure. By ROC subjects working curve drawing, analysis the SBT diaphragm thickness change, diaphragm motion amplitude, diaphragm shallow breathing fast index (D - RSBI) optimal estimation of weaning failure happened and the critical value, and according to the optimal threshold to the continuity of related variables into two categories, the multi-factor Logistic regression analysis, according to the size of the OR value, to value assignment of independent risk factors, assessment is established. The probability of offline success was predicted by the score table. ResultsThe risk of patients with failed withdrawal was divided into three levels according to the phrenic ultrasound rating scale: the low-risk group (0-2 points), the medium-risk group (3-6 points) and the high-risk group (7-8 points). The failure rate of withdrawal in the low-risk group was about 12.5%, the failure rate of withdrawal in the medium-risk group was about 53.7%, and the failure rate of withdrawal in the high-risk group was about 84.8%. ConclusionThe phrenic ultrasound scale was predictive in assessing the risk of weaning patients with mechanical ventilation. |
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