| 摘要: |
| 目的 评估重症肺炎患者入院首次膈肌移动度(diaphragm excursion,DE)对有创机械通气(invasive mechanical ventilation,IMV)支持需求和死亡预后的预测价值。方法 采用回顾性方法,收集2021年9月至2022年8月首都医科大学附属北京朝阳医院急诊医学科收治的成年重症肺炎患者为研究对象,入院12h内行膈肌超声检查。根据住院期间是否行IMV分为机械通气(MV)组和无机械通气(NMV)组；根据入院30天结局分为死亡组和存活组。比较MV组和NMV组DE；比较死亡组和存活组DE；采用受试者工作特征(receiver operating characteristic,ROC)曲线分析DE对重症肺炎IMV需求及死亡预后的预测价值。结果 MV组DE低于NMV组[1.15±0.60(cm)vs. 1.67±0.79(cm),P＜0.05]；死亡组DE低于存活组[1.07±0.59(cm)vs. 1.91±0.70(cm),P＜0.01]。ROC曲线显示,DE预测重症肺炎需要IMV的cut-off值为1.28cm(P＜0.05),灵敏度68.8%,特异度67.7%,曲线下面积(area under curve,AUC )0.694(95%CI：0.547-0.841)；DE预测重症肺炎死亡的cut-off值为1.21cm(P＜0.01),灵敏度68.0%,特异度82.1%,AUC 0.816(95%CI：0.702-0.931)。结论 DE对重症肺炎患者IMV需求和死亡预后具有一定的早期预测价值。 |
| 关键词: 膈肌移动度 超声 重症肺炎 机械通气 预测价值 |
| DOI： |
| 投稿时间：2023-02-27修订日期：2023-09-07 |
| 基金项目: |
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| Predictive Value of Diaphragm Excursion on admission for the need for invasive mechanical ventilation and prognosis of death in Severe Pneumonia patients |
| Yin Li,Ge Huiyu,Wang Siyu,Li Yuanzi,Guo Shubin,Zhang Pu,Guo Ruijun |
| () |
| Abstract: |
| Objective To evaluate the ability of diaphragm excursion (DE) on admission in predicting the need for invasive mechanical ventilation (IMV) and prognosis of death in patients with severe pneumonia. Methods A retrospective study was conducted with severe pneumonia patients admitted to the Emergency Department of Beijing Chaoyang Hospital, Capital Medical University from September 2021 to August 2022. Diaphragm ultrasound were performed within 12 hours of admission to the emergency room. The patients were divided into mechanical ventilation (MV) group and non-mechanical ventilation (NMV) group according to the line whether IMV treatment was needed during hospitalization or not. And they were divided into death group and survival group according to the outcome within 30 days after admission. DE were compared between MV group and NMV group, then between death group and survival group. The predictive values of DE for the need of IMV and prognosis of death in severe pneumonia patients were further evaluated by receiver operating characteristic (ROC) curve. Results DE in MV group were lower than that in NMV group, the difference was statistically significant [1.15±0.60(cm) vs. 1.67±0.79(cm), P＜0.05]. DE in death group were lower than that in survival group, the differences was statistically significant [1.07±0.59(cm) vs. 1.91±0.70(cm), P＜0.01]. ROC curve analysis showed that the cut-off value of DE for predicting the need of IMV in severe pneumonia patients was 1.28cm (P < 0.05), the sensitivity was 68.8%, the specificity was 67.7%, and the AUC was 0.694 (95%CI: 0.547-0.841). The cut-off value of DE for predicting the prognosis of death in severe pneumonia patients was 1.21cm (P < 0.01), the sensitivity was 68.0%, the specificity was 82.1%, and the AUC was 0.816 (95%CI: 0.702-0.931). Conclusions DE had a certain early value in predicting the need for IMV and prognosis of death in severe pneumonia patients. |
| Key words: Diaphragm excursion, Ultrasound, Severe pneumonia, Predictive value |
