[1]杨晓英,顾华杰,戴晓勇,等.重症超声在脓毒症机械通气患者撤机中的评估价值*[J].陕西医学杂志,2020,49(9):1094-1097.[doi:DOI:10.3969/j.issn.1000-7377.2020.09.010]
　YANG Xiaoying,GU Huajie,DAI Xiaoyong,et al.Evaluation value of severe ultrasound in weaning of sepsis patients with mechanical ventilation[J].,2020,49(9):1094-1097.[doi:DOI:10.3969/j.issn.1000-7377.2020.09.010]
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重症超声在脓毒症机械通气患者撤机中的评估价值*
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《陕西医学杂志》[ISSN:1000-7377/CN:61-1281/TN]

卷:
49
期数:
2020年9期
页码:
1094-1097
栏目:
临床研究
出版日期:
2020-09-01

文章信息/Info

Title:
Evaluation value of severe ultrasound in weaning of sepsis patients with mechanical ventilation
作者:
杨晓英; 顾华杰; 戴晓勇; 叶宥文△
同济大学附属杨浦医院急诊科(上海200090)
Author(s):
YANG Xiaoying; GU Huajie; DAI Xiaoyong; et al.
Department of Emergency,Yangpu Hospital,Tongji University(Shanghai 200090)
关键词:
重症超声;  脓毒症;  机械通气;  撤机;  膈肌功能;  肺超声评分
Keywords:
Severe ultrasound;  Sepsis;  Mechanical ventilation;  Weaning;  Diaphragmatic function;  Lung utrasonography score
分类号:
R631
DOI:
DOI:10.3969/j.issn.1000-7377.2020.09.010
文献标志码:
A
摘要:
目的:探讨重症超声在脓毒症机械通气(MV)患者撤机中的评估价值。方法:选取脓毒症患者60例,根据撤机是否成功分为撤机成功组(n=41)和撤机失败组(n=19)。比较两组患者基本资料、心肺指标、膈肌指标的差异,采用Logistic回归分析脓毒症患者MV撤机失败的危险因素,采用 ROC 曲线分析各指标预测撤机结局的价值。结果:与撤机失败组比较,撤机成功组年龄较小,MV时间较短,脓毒症病情较轻,急性生理与慢性健康评分(APACHE Ⅱ)、序贯器官衰竭(SOFA)评分、肺超声(LUS)评分、呼吸频率(RR)、左心房内径(LAD)、浅快呼吸指数(RSBI)较低,左心室射血分数(LVEF)、氧合指数(PaO2/FiO2)、膈肌移动度(DE)、膈肌增厚率(DTF)较高(P<0.05)。Logistic回归分析显示,RSBI、LAD、LUS评分是脓毒症MV患者撤机失败的独立危险因素,而DTF则是保护性因素(P<0.05)。ROC曲线分析显示,RSBI、LAD、DTF、LUS评分联合预测脓毒症MV患者撤机失败的曲线下面积(AUC)为0.956(95%CI:0.920～0.998),灵敏度为94.7%,特异度为97.6%,均高于4个指标的单独预测结果(P<0.05)。结论:除RSBI等传统指标外,结合重症超声监测DTF、LAD、LUS评分等指标有助于提高脓毒症MV患者撤机结局预测准确性,从而指导临床治疗。
Abstract:
Objective:To explore the evaluation value of severe ultrasound in weaning of sepsis patients with mechanical ventilation(MV).Methods:60 patients were divided into weaning success group(n=41)and weaning failure group(n=19)according to whether the weaning was successful or not.Differences in basic data,cardiopulmonary and diaphragmatic indicators of patients in the two groups were compared.The risk factors of MV weaning failure in patients with sepsis were analyzed by Logistic regression.The ROC curve was used to analyze the value of each indicator in predicting the weaning outcome.Results:Compared with weaning failure group,weaning success group had younger age,shorter MV time and milder state of sepsis,and the APEACHE Ⅱ score,SOFA score,LUS score,RR,LAD and RSBI were lower,and the LVEF,PaO2/FiO2,DE and DTF were higher(P<0.05).Logistic regression showed that RSBI,LAD and LUS score were independent risk factors for weaning failure in sepsis patients with MV,while DTF was a protective factor(P<0.05).ROC curve analysis showed that the AUC of the combination of RSBI,LAD,DTF and LUS score in predicting the failure of weaning in sepsis patients with MV was 0.956(95%CI 0.920-0.998),the sensitivity was 94.7%,and the specificity was 97.6%,which was significantly higher than the individual prediction result of the four indicators(P<0.05).Conclusion:In addition to traditional indicators such as RSBI,the combination of DTF,LAD,LUS score monitored by severe ultrasound can improve the prediction accuracy of the weaning outcome of sepsis patients with MV,so as to guide clinical treatment.

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备注/Memo

备注/Memo:
*上海市卫生和计划生育委员会科研课题(201840314)
更新日期/Last Update: 2020-09-02