床旁膈肌超声在重症患者机械通气撤机中的临床研究

Clinical study of bedside diaphragmatic ultrasound in mechanical ventilation weaning of critically ill patients

摘要:

目的 分析床旁膈肌超声在重症患者机械通气撤机中的临床价值。方法 选取2022年5月至2023年5月信阳市中心医院收治的重症机械通气患者80例作为研究对象，依据其撤机结果将患者分为观察组（48例，撤机成功）、对照组（32例，撤机失败）。比较两组自主呼吸实验中0 min、5 min、30 min右侧膈肌位移距离、膈肌收缩速度、膈肌厚度、膈肌厚度增加百分比，并分析应用超声膈肌功能评估的诊断效能。结果 自主呼吸实验中，两组0 min、5 min、30 min右侧膈肌位移距离、膈肌收缩速度随着时间的增加而增加，且观察组变化幅度更大；两组膈肌厚度增加百分比比较，观察组更高（P<0.05）。在预测撤机成功的重症机械通气患者中，设置临界值：右侧膈肌位移距离为1.15 cm（≤1.15 cm为异常，>1.15 cm为正常），膈肌收缩速度为1.45 cm/s（≤1.45 cm/s为异常，>1.45 cm/s为正常），膈肌厚度增加百分比为25%（≤25%为异常，>25%为正常），各膈肌功能指标评估的特异性、灵敏度、准确度较高。结论 在机械通气撤机的重症患者中，应用床旁超声膈肌功能评估，显示撤机成功患者膈肌功能较优，且在预测撤机成功的重症机械通气患者中，超声膈肌功能评估的诊断效能较高。

Abstract:

Objective To analyze the clinical value of bedside diaphragmatic ultrasound in mechanical ventilation weaning in critically ill patients.Methods Eighty severe mechanical ventilation patients admitted to Xinyang Central Hospital from May 2022 to May 2023 were selected and divided into an observation group (48 cases, successful weaning) and a control group (32 cases, failed weaning) based on their weaning results.The right diaphragm displacement, diaphragm contraction velocity (0 min, 5 min, 30 min), diaphragm thickness, and percentage increase in diaphragm thickness were compared between the two groups in the autonomous breathing experiment, and the diagnostic efficacy of ultrasound diaphragm function assessment was analyzed.Results In the autonomous breathing experiment, the displacement distance of the right diaphragm and the contraction speed of the diaphragm increased with time (0 min, 5 min, 30 min), while the control group and observation group increased, and the amplitude of changes in the observation group was greater (compared between the two groups). In the autonomous breathing experiment, the percentage increase in diaphragm thickness was higher in the observation group (P<0.05). In patients with severe mechanical ventilation who successfully predicted weaning, the critical value was set as follows : the right diaphragm displacement distance was 1.15 cm (≤ 1.15 cm was abnormal, >1.15 cm was normal), the diaphragm contraction velocity was 1.45 cm/s (≤ 1.45 cm / s was abnormal, >1.45 cm/s was normal), and the percentage of diaphragm thickness increase was 25%(≤25% was abnormal, >25% was normal). The specificity, sensitivity, and accuracy of the evaluation of various diaphragm function indicators were higher.Conclusion In critically ill patients undergoing mechanical ventilation withdrawal, bedside ultrasound diaphragmatic function assessment showed that patients with successful withdrawal had better diaphragmatic function, and in predicting successful withdrawal in critically ill patients undergoing mechanical ventilation, ultrasound diaphragmatic function assessment had a higher diagnostic efficacy.