文章摘要

超声膈肌功能评估在指导机械通气患者撤机中的应用

作者: 1任 鹏飞, 2朱 凤琴, 1赵 勇
1 安徽医科大学附属阜阳医院急诊医学科,安徽 阜阳 236000
2 安徽医科大学附属阜阳医院超声医学科,安徽 阜阳 236000
通讯: 赵 勇 Email: ayjz@sina.com
DOI: 10.3978/j.issn.2095-6959.2020.04.018

摘要

目的:研究超声膈肌功能评估在指导机械通气患者撤机方面的应用价值,为临床上应用超声撤机提供依据。方法:选取2017年10月至2019年5月安徽医科大学附属阜阳医院70例实施机械通气撤机患者进行研究。依据机械通气患者撤机结果成功与否,将其分为撤机成功的实验组(n=43)和撤机失败的对照组(n=27)。通过两组患者在自主呼吸实验过程中由超声测得的右侧膈肌位移距离、膈肌收缩速度和膈肌厚度增加百分比来评估撤机过程中膈肌的功能情况,由此分析超声膈肌功能评估在撤机成功方面的应用价值。结果:两组患者在自主呼吸实验过程中的右侧膈肌位移距离随时间逐渐增加,且在0,5,30 min时,实验组患者的右侧膈肌位移距离均明显高于对照组,差异均有统计学意义(P<0.05);两组患者在自主呼吸实验过程中的膈肌收缩速度随时间逐渐加快,且在0,5,30 min时,实验组患者的膈肌收缩速度均明显快于对照组,差异均有统计学意义(P<0.05);实验组患者在自主呼吸实验过程中的膈肌厚度增加百分比明显高于对照组,差异有统计学意义(P<0.05)。将1.15 cm设为右侧膈肌位移距离的临界值,应用其撤机成功的灵敏度、准确度和特异性分别为97.67%,94.29%,88.89%;将1.45 cm/s设为膈肌收缩速度的临界值,应用其撤机成功的灵敏度、准确度和特异性分别为93.02%,88.57%,81.48%;将25%设为膈肌厚度增加百分比的临界值,应用其撤机成功的灵敏度、准确度和特异性分别为97.67%,95.71%,92.59%。结论:超声膈肌功能评估可以有效地指导临床机械通气患者撤机,通过超声对右侧膈肌位移距离、膈肌收缩速度和膈肌厚度增加百分比进行评估,患者撤机的成功率得到明显提高,且上述指标具有较高的灵敏度、准确度和特异性。因此,超声膈肌功能评估在指导机械通气患者撤机方面有很高的应用价值,可在临床上推广应用。
关键词: 超声;机械通气;撤机;膈肌功能;应用价值

Application of ultrasound diaphragmatic function assessment in guiding mechanical evacuation of patients with mechanical ventilation

Authors: 1REN Pengfei, 2ZHU Fengqin, 1ZHAO Yong
1 Department of Emergency Medicine, Fuyang Hospital Affiliated to Anhui Medical University, Fuyang Anhui 236000, China
2 Department of Ultrasound Medicine, Fuyang Hospital Affiliated to Anhui Medical University, Fuyang Anhui 236000, China

CorrespondingAuthor:ZHAO Yong Email: ayjz@sina.com

Abstract

Objective: To study the application value of ultrasound diaphragmatic function assessment in guiding mechanical evacuation of patients with mechanical ventilation, and to provide evidence for clinical application of ultrasonic weaning. Methods: Seventy patients who underwent mechanical ventilation and weaning in our hospital from October 2017 to May 2019 were selected for research. According to the success or failure of mechanical ventilation patients, they were divided into an experimental group (n=43) with successful weaning and a control group with negative (n=27). The function of the diaphragm in the process of weaning was evaluated by the distance between the right diaphragmatic displacement, the diaphragmatic contraction speed and the percentage increase of the diaphragm thickness measured by ultrasound in the two groups of patients during the spontaneous breathing test to analyze the value of application in the success of weaning. Results: The displacement distance of the right diaphragm was gradually increased with time during the spontaneous breathing experiment. At 0, 5 and 30 min, the displacement distance of the right diaphragm was significantly higher in the experimental group than in the control group (P<0.05); the contraction speed of diaphragm in the two groups of patients during the spontaneous breathing experiment gradually increased with time, and at 0, 5 and 30 min, the contraction velocity of the diaphragm in the experimental group was significantly faster than that in the control group (P<0.05). The percentage of diaphragmatic muscle thickness increase in the experimental group was significantly higher than that in the control group (P<0.05). When 1.15 cm was set as the critical value of the displacement distance of the right diaphragm, the sensitivity, accuracy and specificity of applying the suture success were 97.67%, 94.29%, and 88.89% respectively; when 1.45 cm/s was set as the contraction speed of the diaphragm, the sensitivity, accuracy and specificity of applying the successful weaning were 93.02%, 88.57%, and 81.48%, respectively; when 25% was set as the critical value of the percentage increase of the diaphragm thickness, the sensitivity, accuracy and specificity of applying the successful weaning were 97.67%, 95.71%, and 92.59%, respectively. Conclusion: The evaluation of ultrasound diaphragmatic function can effectively guide the clinical mechanical ventilation patients to withstand the machine. After the evaluation of the displacement distance of the right diaphragm, the contraction speed of the diaphragm and the increase of the thickness of the diaphragm muscle by ultrasound, the success rate of the patient's weaning is significantly improved, and the above indicators have high sensitivity, accuracy and specificity. Therefore, the evaluation of ultrasound diaphragmatic function has a high application value in guiding the mechanical evacuation of patients with mechanical ventilation, and can be widely applied in clinical practice.
Keywords: ultrasound; mechanical ventilation; withdraw machine; diaphragm function; application value