中国呼吸与危重监护杂志

中国呼吸与危重监护杂志

膈肌浅快呼吸指数对机械通气慢性阻塞性肺疾病患者撤机的预测价值

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目的探讨膈肌浅快呼吸指数(diaphragm rapid shallow breathing index,D-RBSI)对机械通气慢性阻塞性肺疾病(简称慢阻肺)患者撤机结果的预测价值。方法纳入 2016 年 3 月至 2017 年 3 月我院重症医学科收治的 76 例机械通气慢阻肺患者。患者通过撤机筛查后以持续气道正压通气模式进行自主呼吸试验(spontaneous breathing test,SBT),SBT 开始后 10 min 或 SBT 失败时记录患者的呼吸频率( respiratory rate,RR)和潮气量,并利用床旁超声测量患者的膈肌活动度(diaphragmatic displacement,DD)。以 RR 和 DD 的比值(RR/DD)计算 D-RBSI,通过受试者工作特征(receiver operating characteristic,ROC)曲线分析 D-RBSI 对机械通气慢阻肺患者撤机结果的预测价值。结果共有 28 例患者撤机失败。成功组和失败组患者的年龄和急性生理学和慢性健康状况评分系统Ⅱ评分无明显差异。成功组患者 DD 大于失败组[(22±6)mm 比(13±5)mm,P<0.001)],RBSI 和 D-RBSI 均低于失败组[RBSI:(40±14)次/(min·L)比(52±20)次/(min·L),P=0.003;D-RBSI:(0.95±0.51)次/(min·mm)比(1.79±0.83)次/(min·mm),P<0.001)]。两组患者的 RBSI 和 D-RBSI 之间相关性良好(R2=0.778,P<0.001)。D-RBSI 对患者撤机结果预测的 ROC 曲线下面积高于 RBSI [(0.85 比 0.75,P<0 001="" d-rbsi="">1.13 次/(min·mm)预测撤机失败的敏感性为 0.82,特异性为 0.81。结论超声监测机械通气慢阻肺患者 SBT 时 D-RBSI 可有效判断其撤机结果。

ObjectiveTo investigate the predictive value of diaphragm rapid shallow breathing index (D-RBSI) in weaning from mechanical ventilation in patients with chronic obstructive pulmonary disease (COPD).MethodsSeventy-six patients with COPD who were undergoing mechanical ventilation were enrolled in department of critical care medicine of our hospital from March 2016 to March 2017. The patient underwent spontaneous breathing test (SBT) using CPAP mode after weaning screening. When the SBT had started 10 min or the SBT failed, the patients' respiratory rate (RR) and tidal volume were recorded, and the diaphragmatic displacement (DD) of patients was measured by bedside ultrasound. The ratio of RR to DD (RR/DD) was calculated as D-RBSI, and the predictive value of D-RBSI on weaning results in mechanically ventilated patients with COPD was analyzed by receiver operating characteristic (ROC) curve.ResultsTwenty-eight patients failed weaning procedure. There were no significant differences in age and acute physiology and chronic health evaluation II scores between the successful group and the failed group. The DD of the patients in the successful group was greater than that of the failed group [(22±6) mm vs. (13±5) mm, P<0.001]. RBSI and D-RBSI of the successful group were lower than those of the failure group [RBSI: (40±14) breaths/(min·L)vs. (52±20) breaths/(min·L), P=0.003; D-RBSI: (0.95±0.51) breaths/(min·mm) vs. (1.79±0.83) breaths/(min·mm), P<0.001)]. There was a good correlation between the RBSI and D-RBSI in the two groups (R2=0.778, P<0.001). The area under the ROC curve predicted the weaning result by D-RBSI was higher than RBSI (0.85vs. 0.75, P<0 001="" the="" cutoff="" value="" of="" d-rbsi="">1.13 breaths/(min·mm) to predict weaning failure had a sensitivity of 0.82, and a specificity of 0.81.ConclusionThe rapid shallow breathing index of diaphragm can be effectively used to predict the weaning result of COPD patients during mechanical ventilation.

关键词: 慢性阻塞性肺疾病; 呼吸浅快指数; 机械通气; 撤机

Key words: Chronic obstructive pulmonary disease; Rapid shallow breathing index; Mechanical ventilation; Weaning

引用本文: 窦志敏, 李红, 朱磊, 陈启明, 李斌, 刘健. 膈肌浅快呼吸指数对机械通气慢性阻塞性肺疾病患者撤机的预测价值. 中国呼吸与危重监护杂志, 2018, 17(2): 124-127. doi: 10.7507/1671-6205.201712001 复制

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