Li Tianyuan, Wu Xiong-Zhi, Long Dingde, Fu Huan, Guo Suping, Liu Fen
Department of Anesthesiology, The First Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, Jiangxi, China.
Department of Anesthesiology, Shaoxing People's Hospital, Shaoxing, Zhejiang, China.
PeerJ. 2024 Dec 19;12:e18677. doi: 10.7717/peerj.18677. eCollection 2024.
Pre-operative pulmonary function testing (PFT) plays a key role in predicting postoperative complications or functional impairment. However, PFT requires the subject and examiner to cooperate and the results are influenced by both technical and personal factors. In contrast, the use of ultrasound (US) for structural and functional assessments of the lungs and diaphragm is on the rise, as it requires minimal patient cooperation. Dyspnea is mainly caused by lung or pleural lesions but may also be caused by weak respiratory muscles. As the diaphragm is a primary respiratory muscle, combining lung ultrasonography (LUS) with diaphragm ultrasound (DUS) may enable a more comprehensive assessement of pulmonary function. This study aims to introduce a novel approach for assessing pulmonary function using a mathematical model based on LUS and DUS.
This prospective study was performed at the First Affiliated Hospital of Nanchang University between June 2021 and December 2021, 208 patients were recruited and underwent PFT, LUS, and DUS examinations. An experienced physician, blinded to the clinical history and PFT results, performed LUS and DUS and explored the correlations between a mathematical model (ultrasonographic modeling score (U-score)) using LUS combined with DUS and pulmonary function parameters. Univariate, multivariate, and logistic regression analyses were also performed.
According to the univariate and multivariable analysis, diaphragm thickness fraction in deep breathing (D-DTF) (odds ratio (OR), 0.88; 95% confidence interval (CI) [0.83-0.94]; < 0.001), and LUS score (OR, 1.44; 95% CI [1.16-1.80]; < 0.001) were each independently associated with pulmonary function. According to the logistics equation, a U-score of -0.126 × D-DTF + 0.368 × LUS score was produced. The U-score showed a more significant negative correlation with forced expiratory volume in the first second/forced vital capacity (FEV1/FVC) (r = -0.605, < 0.001) than the LUS or DUS indices alone. The U-score (area under the curve (AUC) = 0.971) was greater than the other indices for assessing pulmonary function.
With validation, the U-score through both lung and diaphragm ultrasound measurements may assist in estimating pulmonary function. This approach facilitates the assessment of pulmonary function in patients who may be unable to reliably participate in PFT.
术前肺功能测试（PFT）在预测术后并发症或功能损害方面起着关键作用。然而，PFT需要受试者和检查者配合，其结果受技术和个人因素影响。相比之下，由于超声（US）对肺和膈肌进行结构及功能评估时所需患者配合极少，其应用正在增加。呼吸困难主要由肺部或胸膜病变引起，但也可能由呼吸肌无力所致。由于膈肌是主要呼吸肌，将肺部超声检查（LUS）与膈肌超声检查（DUS）相结合，可能会更全面地评估肺功能。本研究旨在介绍一种基于LUS和DUS的数学模型评估肺功能的新方法。
这项前瞻性研究于2021年6月至2021年12月在南昌大学第一附属医院进行，招募了208例患者并对其进行PFT、LUS和DUS检查。由一名对临床病史和PFT结果不知情的经验丰富的医生进行LUS和DUS检查，并探究使用LUS与DUS相结合的数学模型（超声建模评分（U评分））与肺功能参数之间的相关性。还进行了单因素、多因素和逻辑回归分析。
根据单因素和多因素分析，深呼吸时的膈肌厚度分数（D-DTF）（比值比（OR），0.88；95%置信区间（CI）[0.83 - 0.94]；P < 0.001）和LUS评分（OR，1.44；95%CI[1.16 - 1.80]；P < 0.001）各自独立与肺功能相关。根据逻辑方程，得出U评分为 -0.126×D-DTF + 0.368×LUS评分。与单独的LUS或DUS指标相比，U评分与第一秒用力呼气量/用力肺活量（FEV1/FVC）的负相关性更强（r = -0.605，P < 0.001）。U评分（曲线下面积（AUC） = 0.971）在评估肺功能方面优于其他指标。
经验证，通过肺和膈肌超声测量得出的U评分可能有助于评估肺功能。这种方法便于对可能无法可靠参与PFT的患者进行肺功能评估。
