Liu L X, Su D, Hu Z J
Department of Critical Care Medicine, the Fourth Hospital of Hebei Medical University, Shijiazhuang 050011, China.
Zhonghua Nei Ke Za Zhi. 2017 Jul 1;56(7):495-499. doi: 10.3760/cma.j.issn.0578-1426.2017.07.005.
To evaluate the excursion of the diaphragm and analyze the value in predicting weaning from mechanical ventilation in intensive care unit patients. The patients with mechanical ventilation (>48 hours) in ICU at Hebei Forth Medical University Hospital from June 2014 to December were classified into a success group or a failure group according to the weaning outcome. T-piece spontaneous breathing (SBT), airway occlusion pressure at 0.1 sec (P(0.1)) and maximal inspiratory pressure (MIP), rapid shallow breathing index (RSBI) and P(0.1)/MIP were measured or calculated. During the period of the 1st hour SBT, the excursion of diaphragm was measured with ultrasonography. The predictive value of each parameter to weaning was evaluated with ROC curve. A total of 98 patients were enrolled in this study, including 74 successfully weaning and 24 failed. There were significant differences between two groups(success group and failure group) in P(0.1)[(2.00±2.00)cmH(2)O (1 cmH(2)O=0.098 kPa) vs (3.00±2.75)cmH(2)O, <0.05], RSBI (39.14±16.81 vs 52.00±19.18, <0.05), left diaphragmatic excursion [(1.12±0.97)cm vs (0.69±1.00)cm, <0.001], right diaphragmatic excursion(1.87±0.75)cm vs (1.17±0.76)cm, <0.001] and mean value of left and right diaphragmatic excursion [(1.57±0.52)cm vs (0.83±0.53)cm, and <0.001]. The ventilation time [2.00(2.00-4.00)d vs 4.00(2.00-5.00)d], ICU hospital lengths of stay [4.50(3.00-7.25)d vs 8.50(6.25-15.25)d] and total hospital lengths of stay[20.00(15.00-25.25)d vs 25.00(20.25-37.25)d] were also statistically significant in success group and failure group respectively (all <0.05). The cutoff value of diaphragmatic excursion for predicting successful extubation was determined to be 1.14 cm by ROC curve analysis. The sensitivity of diaphragmatic excursion to predict successful weaning was 89.2% and the specificity was 75.0%, the AUC(ROC) was 0.849. As an early predictor of diaphragmatic dysfunction, diaphragmatic excursion is probably superior to the traditional parameters in predicting weaning from ventilator in ICU patients.
评估膈肌活动度，并分析其对重症监护病房患者机械通气撤机预测的价值。选取2014年6月至12月在河北北方学院附属第四医院重症监护病房接受机械通气（>48小时）的患者，根据撤机结果分为成功组和失败组。测量或计算T管自主呼吸（SBT）、0.1秒气道闭塞压（P(0.1)）、最大吸气压力（MIP）、快速浅呼吸指数（RSBI）及P(0.1)/MIP。在SBT第1小时期间，用超声测量膈肌活动度。用ROC曲线评估各参数对撤机的预测价值。本研究共纳入98例患者，其中74例成功撤机，24例撤机失败。成功组与失败组在P(0.1)（(2.00±2.00)cmH₂O（1 cmH₂O = 0.098 kPa） vs (3.00±2.75)cmH₂O，<0.05）、RSBI（39.14±16.81 vs 52.00±19.18，<0.05）、左侧膈肌活动度（(1.12±0.97)cm vs (0.69±1.00)cm，<0.001）、右侧膈肌活动度（(1.87±0.75)cm vs (1.17±0.76)cm，<0.001）及左右膈肌活动度均值（(1.57±0.52)cm vs (0.83±0.53)cm，<0.001）方面存在显著差异。成功组与失败组的机械通气时间[2.00(2.00 - 4.00)天 vs 4.00(2.00 - 5.00)天]、重症监护病房住院时间[4.50(3.00 - 7.25)天 vs 8.50(6.25 - 15.25)天]及总住院时间[20.00(15.00 - 25.25)天 vs 25.00(20.25 - 37.25)天]也有统计学差异（均<0.05）。通过ROC曲线分析确定膈肌活动度预测成功拔管的截断值为1.14 cm。膈肌活动度预测成功撤机的敏感度为89.2%，特异度为75.0%，AUC(ROC)为0.849。作为膈肌功能障碍的早期预测指标，膈肌活动度在预测重症监护病房患者机械通气撤机方面可能优于传统参数。
