膈肌超声对慢性阻塞性肺疾病急性加重期患者机械通气结局的预测价值。
Predictive value of diaphragm ultrasound for mechanical ventilation outcome in patients with acute exacerbation of chronic obstructive pulmonary disease.
作者信息
Qu Lei-Lei, Zhao Wen-Ping, Li Ji-Ping, Zhang Wei
机构信息
The First Department of Respiratory and Critical Care Medical Center, The First People's Hospital of Baiyin City, Baiyin 730900, Gansu Province, China.
Department of Nursing, The First People's Hospital of Baiyin City, Baiyin 730900, Gansu Province, China.
出版信息
World J Clin Cases. 2024 Sep 16;12(26):5893-5900. doi: 10.12998/wjcc.v12.i26.5893.
BACKGROUND
Acute exacerbation of chronic obstructive pulmonary disease (AECOPD) is often combined with respiratory failure, which increases the patient's morbidity and mortality. Diaphragm ultrasound (DUS) has developed rapidly in the field of critical care in recent years. Studies with DUS monitoring diaphragm-related rapid shallow breathing index have demonstrated important results in guiding intensive care unit patients out of the ventilator. Early prediction of the indications for withdrawal of non-invasive ventilator and early evaluation of patients to avoid or reduce disease progression are very important.
AIM
To explore the predictive value of DUS indexes for non-invasive ventilation outcome in patients with AECOPD.
METHODS
Ninety-four patients with AECOPD who received mechanical ventilation in our hospital from January 2022 to December 2023 were retrospectively analyzed, and they were divided into a successful ventilation group (68 cases) and a failed ventilation group (26 cases) according to the outcome of ventilation. The clinical data of patients with successful and failed noninvasive ventilation were compared, and the independent predictors of noninvasive ventilation outcomes in AECOPD patients were identified by multivariate logistic regression analysis.
RESULTS
There were no significant differences in gender, age, body mass index, complications, systolic pressure, heart rate, mean arterial pressure, respiratory rate, oxygen saturation, partial pressure of oxygen, oxygenation index, or time of inspiration between patients with successful and failed mechanical ventilation ( > 0.05). The patients with successful noninvasive ventilation had shorter hospital stays and lower partial pressure of carbon dioxide (PaCO) than those with failed treatment, while potential of hydrogen (pH), diaphragm thickening fraction (DTF), diaphragm activity, and diaphragm movement time were significantly higher than those with failed treatment ( < 0.05). pH [odds ratio (OR) = 0.005, < 0.05], PaCO (OR = 0.430, < 0.05), and DTF (OR = 0.570, < 0.05) were identified to be independent factors influencing the outcome of mechanical ventilation in AECOPD patients.
CONCLUSION
The DUS index DTF can better predict the outcome of non-invasive ventilation in AECOPD patients.
背景
慢性阻塞性肺疾病急性加重期（AECOPD）常合并呼吸衰竭，增加患者发病率和死亡率。近年来，膈肌超声（DUS）在重症监护领域发展迅速。有关DUS监测膈肌相关快速浅呼吸指数的研究已在指导重症监护病房患者脱机方面取得重要成果。早期预测无创通气撤机指征并对患者进行早期评估以避免或减少疾病进展非常重要。
目的
探讨DUS指标对AECOPD患者无创通气结局的预测价值。
方法
回顾性分析2022年1月至2023年12月在我院接受机械通气的94例AECOPD患者，根据通气结局将其分为通气成功组（68例）和通气失败组（26例）。比较无创通气成功与失败患者的临床资料，并通过多因素logistic回归分析确定AECOPD患者无创通气结局的独立预测因素。
结果
机械通气成功与失败患者在性别、年龄、体重指数、并发症、收缩压、心率、平均动脉压、呼吸频率、血氧饱和度、氧分压、氧合指数或吸气时间方面无显著差异（P>0.05）。无创通气成功患者的住院时间较短，二氧化碳分压（PaCO）低于治疗失败患者，而酸碱度（pH）、膈肌增厚分数（DTF）、膈肌活动度和膈肌移动时间显著高于治疗失败患者（P<0.05）。pH[比值比（OR）=0.005，P<0.05]、PaCO（OR = 0.430，P<0.05）和DTF（OR = 0.570，P<0.05）被确定为影响AECOPD患者机械通气结局的独立因素。
结论
DUS指标DTF能更好地预测AECOPD患者无创通气结局。
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