Zhang Lei, Chen Guozhong, Wang Huaying, Yu Wanjun
Department of Respiratory and Critical Care Medicine, People's Hospital Affiliated to Ningbo University, Ningbo 315040, Zhejiang, China.
Department of Intensive Care Unit, People's Hospital Affiliated to Ningbo University, Ningbo 315040, Zhejiang, China. Corresponding author: Yu Wanjun, Email:
Zhonghua Wei Zhong Bing Ji Jiu Yi Xue. 2022 Sep;34(9):941-946. doi: 10.3760/cma.j.cn121430-20220303-00200.
To investigate the clinical predictive value of combined diaphragmatic and pulmonary ultrasound in acute respiratory failure patients with mechanical ventilation (MV).
From January 2020 to August 2022, patients with acute respiratory failure admitted to People's Hospital Affiliated to Ningbo University who underwent invasive MV and weaning were enrolled. After meeting the weaning standards, spontaneous breathing test (SBT) was performed using T-tube. Right diaphragm excursion (DE), diaphragm thickness and lung ultrasound score (LUS) were collected by bedside ultrasound at 30 minutes of SBT, and rapid shallow respiratory index (RSBI), diaphragmatic-shallow respiratory index (D-RSBI) and diaphragmatic thickening rate (DTF) were calculated. According to the weaning outcome, the patients were divided into successful weaning group and failed weaning group. The clinical data of all patients were collected, and the ultrasound parameters and clinical indicators were compared between the two groups. Receiver operator characteristic curve (ROC curve) was used to evaluate the predictive value of D-RSBI, RSBI, DE combined with LUS score and DTF combined with LUS score for weaning failure patients.
A total of 77 patients were enrolled, including 54 cases in the successful weaning group and 23 cases in the failed weaning group. The right DE and DTF of patients in successful weaning group were significantly higher than those in failed weaning group [right DE (cm): 1.28±0.39 vs. 0.88±0.41, DTF: (32.64±18.27)% vs. (26.43±15.23)%, both P < 0.05], LUS score, RSBI and D-RSBI were significantly lower than those in failed weaning group [LUS score: 11.45±2.67 vs. 18.33±3.62, RSBI (times×min×L): 72.21±19.67 vs. 107.35±21.32, D-RSBI (times×min×mm): 0.97±0.19 vs. 1.78±0.59, all P < 0.05]. ROC curve analysis showed that when the cut-off value of D-RSBI and RSBI was 1.41 times×min×mm and 56.46 times×min×L, the area under the ROC curve (AUC) for predicting weaning failure was 0.972 and 0.988; and the sensitivity was 95.7% and 87.0%, respectively; the specificity was 81.0% and 100.0%, respectively. The AUC of right DE combined with LUS score and DTF combined with LUS score in predicting weaning failure were 0.974 and 0.985, respectively, with a sensitivity of 91.3% and a specificity of 98.1%.
Combined assessment of diaphragmatic and pulmonary ultrasound is a good parameter to effectively predict weaning failure in MV patients, which has high application value in guiding weaning in MV patients, and is worthy of clinical application.
探讨膈肌与肺部联合超声对机械通气（MV）急性呼吸衰竭患者的临床预测价值。
选取2020年1月至2022年8月在宁波大学附属人民医院住院的急性呼吸衰竭且接受有创MV及撤机的患者。符合撤机标准后，采用T管进行自主呼吸试验（SBT）。在SBT 30分钟时床边超声采集右侧膈肌移动度（DE）、膈肌厚度及肺部超声评分（LUS），并计算快速浅呼吸指数（RSBI）、膈肌 - 浅呼吸指数（D - RSBI）及膈肌增厚率（DTF）。根据撤机结果将患者分为撤机成功组和撤机失败组。收集所有患者的临床资料，比较两组间超声参数及临床指标。采用受试者工作特征曲线（ROC曲线）评估D - RSBI、RSBI、DE联合LUS评分及DTF联合LUS评分对撤机失败患者的预测价值。
共纳入77例患者，其中撤机成功组54例，撤机失败组23例。撤机成功组患者的右侧DE及DTF显著高于撤机失败组[右侧DE（cm）：1.28±0.39比0.88±0.41，DTF：（32.64±18.27）%比（26.43±15.23）%，均P < 0.05]，LUS评分、RSBI及D - RSBI显著低于撤机失败组[LUS评分：11.45±2.67比18.33±3.62，RSBI（次×分×升）：72.21±19.67比107.35±21.32，D - RSBI（次×分×毫米）：0.97±0.19比1.78±0.59，均P < 0.05]。ROC曲线分析显示，当D - RSBI和RSBI的截断值分别为1.41次×分×毫米和56.46次×分×升时，预测撤机失败的ROC曲线下面积（AUC）分别为0.972和0.988；敏感性分别为95.7%和87.0%；特异性分别为81.0%和100.0%。右侧DE联合LUS评分及DTF联合LUS评分预测撤机失败的AUC分别为0.974和0.985，敏感性为91.3%，特异性为98.1%。
膈肌与肺部联合超声评估是有效预测MV患者撤机失败的良好参数，在指导MV患者撤机方面具有较高应用价值，值得临床应用。
