Lu Zhihua, Ge Huiqing, Xu Lilong, Guo Feng, Zhang Ge, Wu Yinshan
Department of Critical Care Medicine, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China.
Department of Respiratory Care, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China.
J Clin Ultrasound. 2019 May;47(4):206-211. doi: 10.1002/jcu.22690. Epub 2019 Jan 22.
To assess alteration of diaphragmatic function by ultrasonography in a population of mechanically ventilated patients with or without sepsis.
We performed a prospective, 6-month, single-center, observational cohort study. Mechanically ventilated septic and nonseptic patients were studied within 24 hours following intubation and before the moment of ventilator liberation. Diaphragm thickness and contractile activity (quantified by diaphragmatic thickening fraction, DTF) were measured by ultrasonography at the zone of apposition. Intraobserver and interobserver reproducibility were measured.
Fifty-two critically ill patients were included, 28 with sepsis and 24 without sepsis. Upon initiation of ventilation, DTF was lower in septic than that in nonseptic patients (P = 0.03). No difference was observed between septic and nonseptic patients for diaphragm thickness. Mean 188 ± 111 hours after the first measurement, both diaphragm thickness and DTF decreased significantly compared with first measurements in septic and nonseptic patients, all P < 0.001. Diaphragm thickness decreased by 9.1 ± 10.7% in nonseptic and by 16.0 ± 13.5% in septic patients, P = 0.049. DTF decreased by 15.2 ± 21.3% in nonseptic and by 30.7 ± 22.0% in septic patients, P = 0.013.
Mechanically ventilated patients with sepsis were associated with an earlier and more severe diaphragm dysfunction compared with patients without sepsis.
通过超声检查评估有或无脓毒症的机械通气患者的膈肌功能改变。
我们进行了一项为期6个月的前瞻性单中心观察性队列研究。在插管后24小时内且在呼吸机撤离前，对机械通气的脓毒症和非脓毒症患者进行研究。通过超声检查在膈肌附着区测量膈肌厚度和收缩活动（通过膈肌增厚分数，DTF量化）。测量观察者内和观察者间的可重复性。
纳入52例危重症患者，28例有脓毒症，24例无脓毒症。通气开始时，脓毒症患者的DTF低于非脓毒症患者（P = 0.03）。脓毒症和非脓毒症患者的膈肌厚度无差异。首次测量后平均188±111小时，脓毒症和非脓毒症患者的膈肌厚度和DTF均较首次测量时显著降低，所有P < 0.001。非脓毒症患者的膈肌厚度降低9.1±10.7%，脓毒症患者降低16.0±13.5%，P = 0.049。非脓毒症患者的DTF降低15.2±21.3%，脓毒症患者降低30.7±22.0%，P = 0.013。
与无脓毒症的患者相比，有脓毒症的机械通气患者膈肌功能障碍出现更早且更严重。
