床旁膈肌联合心脏超声在有创机械通气患者撤机中的应用
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蚌埠医科大学第一附属医院

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Application of Bedside Diaphragmatic Ultrasonography and Transthoracic Echocardiography in Patients with Invasive Mechanical Ventilation
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the first affiliated hospital of bengbu medical university

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    摘要:

    目的 探讨床旁膈肌联合心脏超声检测膈肌移动度(DE)、二尖瓣舒张早期峰值血流速度(E)/ 二尖瓣瓣环舒张早期峰速(e?)、左室射血分数(LVEF)等指标在有创机械通气患者撤机中的应用价值。方法 选取2019 年1 月至2023 年8 月在蚌埠医科大学第一附属医院呼吸重症监护室进行有创机械通气的50 例患者作为研究对象,根据撤机结局将其分为撤机成功组与撤机失败组,收集两组患者的一般资料及DE、E/e?、LVEF 水平,并评估DE、E/e?、LVEF 水平联合预测有创机械通气患者撤机结局的价值。结果 有创呼吸机撤机前撤机成功组患者的DE、LVEF 水平分别为(1.17±0.26)cm、(56.84±7.02)%,高于撤机失败组的(0.86±0.17)cm、(46.33±6.86)%,差异具有统计学意义(P < 0.05),而撤机成功组患者的E/e? 水平(9.64±1.08)低于撤机失败组患者(10.67±1.17),差异具有统计学意义(P < 0.05)。ROC 曲线 分析结果显示,DE、E/e?、LVEF 水平预测有创机械通气患者撤机结局的AUC 分别为0.827、0.721、0.763,三者联合预测有创机械通气患者撤机结局的AUC 为0.935。结论 有创机械通气患者床旁膈肌联合心脏超声检测DE、E/e?、LVEF 等指标水平可以预测患者撤机结局,有助于进一步提高呼吸机撤机结局预测的准确性。

    Abstract:

    Objective To investigate the value of bedside diaphragmic ultrasonography combined with transthoracic echocardiography in detecting diaphragmic excursion (DE), mitral valve early diastolic peak flow velocity (E)/mitral annular early diastolic peak velocity (e?), and left ventricular ejection fraction (LVEF) in the weaning patients with invasive mechanical ventilation. Methods Fifty patients who underwent invasive mechanical ventilation in the respiratory intensive care unit of the First Affiliated Hospital of Bengbu Medical University from January 2019 to August 2023 were selected as the study subjects, and they were divided into the successful weaning group and the failed weaning group according to the outcome of the weaning, and the general data and DE, E/e?, and LVEF levels of the patients in the two groups were collected and evaluated to assess the joint prediction of invasive by the levels of DE, E/e?, and LVEF in the value of weaning outcome in mechanically ventilated patients. Results The DE and LVEF levels of patients in the successful weaning group before weaning of invasive mechanical ventilation were (1.17±0.26) cm and (56.84±7.02)%, respectively, which were higher than those of patients in the unsuccessful weaning group (0.86±0.17) cm and (46.33±6.86)%, and the differences were statistically significant (P < 0.05), whereas the E/e? levels of patients in the successful weaning group (9.64± 1.08) were lower than those of patients in the failed machine weaning group (10.67±1.17), and the difference was statistically significant (P < 0.05). The results of ROC curve analysis showed that the AUCs of DE, E/e?, LVEF, and their combined test for predicting the outcome of weaning patients with invasive mechanical ventilation were 0.827, 0.721, and 0.763, respectively, and the AUC for the combination of the three for predicting the outcome of weaning in patients with invasive mechanical ventilation was 0.935. Conclusions Bedside diaphragmic ultrasonography combined with transthoracic echocardiography in invasive mechanically ventilated patients to detect the levels of DE, E/e?, and LVEF can predict patients’ weaning outcome, which helps to further improve the accuracy of predicting ventilator weaning outcome.

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姜艳茹.床旁膈肌联合心脏超声在有创机械通气患者撤机中的应用[J].生物医学工程学进展,2024,45(4):381-386

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  • 收稿日期:2024-10-16
  • 最后修改日期:2024-10-30
  • 录用日期:2024-11-03
  • 在线发布日期: 2025-01-08
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