| 摘要: |
| [摘要] 目的：评估肺超声动态监测肺水变化联合膈肌功能对重症机械通气（MV）患者撤机的预测价值。
方法：选取重症医学科112例接受MV＞48h并符合撤机条件患者，于自主呼吸试验（SBT）0min采用床旁超声测量左室射血分数（LVEF）、左室短轴缩短率（LVFS）、舒张功能指标和胸前区肺超声水肿评分（A-LUES 0min）；于SBT 15min测量膈肌移动度（DE）及A-LUES 15min，并计算△A-LUES。采用ROC曲线评价各指标预测撤机结果的价值。
结果：64例撤机成功（成功组），48例撤机失败（失败组），失败组LVEF、DE、e’明显低于成功组，E/e’、A-LUES 15min、△A-LUES明显高于成功组（P＜0.05）；分别以51.50%、6.48cm/s、10.36、10.35mm、1.50分作为LVEF、e’、E/e’、DE和△A-LUES的阈值，预测撤机结果的敏感度分别为 93.75%、90.63%、62.50%、85.94%和77.08%，特异度分别为27.08%、52.08%、75.00%、56.25%和67.19%，AUC分别为0.613、0.735、0.652、0.786和0.793；△A-LUES联合DE对预测撤机结果的敏感度为89.58%，特异度为82.81%，AUC为0.909。
结论：超声监测肺水动态变化、膈肌功能和左心功能对撤机成败有较好的预测价值。 |
| 关键词: 机械通气 肺超声 膈肌 超声检查 肺水肿 |
| DOI： |
| 投稿时间：2022-02-15修订日期：2022-03-13 |
| 基金项目:河北省医学科学研究重点课题计划（20200774、20211264）；河北省科技计划项目（20277741D） |
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| Predictive value of dynamic lung ultrasound, diaphragm and left ventricular function in weaning of critically ill patients with mechanical ventilation |
| zhaohaotian,wanghuawei,lili,longling,zhaoheling,liuyuanlin |
| (Hebei General Hospital) |
| Abstract: |
| ABSTRACT Objective： To evaluate the predictive value of dynamic monitoring changes of lung water combined with diaphragm function in critical patients with mechanical ventilation (MV).
Method: Totally 112 critical patients with MV in ICU more than 48 hours were prepared to weaning from MV were enrolled. During the spontaneous breathing trial (SBT), the left ventricular ejection fraction (LVEF), left ventricular fractional shortening (LVFS), index of left ventricular diastolic function, and anterior chest wall lung ultrasound edema score (A-LUES 0min) were measured at the 0 min by ultrasound. Diaphragmatic excursion (DE) and A-LUES 15min were measured at the 15min, and △A-LUES (A-LUES 15min - A-LUES 0min) was calculated. ROC curve was used to evaluate the value of each index to predict the weaning outcomes.
Results: There were 64 cases weaning successful (successful group) and 48 weaning failure (falure group). LVEF, DE, e’ in falure group were significantly lower than that in successful group, and E/e’, A-LUES 15min, △A-LUES were significantly higher than that in successful group. Choose 51.50%, 6.48cm/s, 10.36, 10.35mm, 1.50 points as the cut-off value of LVEF, e’, E/e’, DE and △A-LUES, the sensitivity were 93.75%, 90.63%, 62.50%, 85.94% and 77.08%, respectively. the specificity were 27.08%, 52.08%, 75.00%, 56.25% and 67.19%, respectively. The AUC were0.613, 0.735, 0.652, 0.786 and 0.793, respectively.
Conclusion: dynamic lung ultrasound monitoring combined with diaphragm function and left ventricular dysfunction have better predictive value for the outcomes of weaning. |
| Key words: Mechanical ventilation Lung ultrasound Diaphragm Ultrasonography examination Edema |
