标题：重症超声诊断方案在机械通气患者撤机中的应用

      作者：方军 1，李冰冰 1，潘晓洁 2，李志延 1，朱岩 3，张祎 1，赵鹏 1，王会迟 1    (中国石油天然气集团公司中心医院重症医学科 1、超声科 2、针灸科 3，河北 廊坊 065000)

      卷次： 2017年28卷8期

      【摘要】 目的 探讨超声诊断方法应用于机械通气重症患者撤机时的临床价值。方法 回顾性分析我院2012年7月至2015年7月接诊的予以机械通气治疗的98例重症患者的临床资料，根据撤机成功与否分为撤机成功组(47例)与撤机失败组(51例)。两组患者均行超声监测和自主呼吸试验(SBT)，比较组间不同时间节点中最大右侧膈肌位移(DE)和膈肌收缩速度的变化，分析二者数值变化对撤机的预测价值。结果 SBT中两组DE在不同时间节点(0 min、5 min、30 min)均逐渐升高(P<0.05)，不同时间节点上，撤机成功组DE分别为(1.05±0.29) mm、(1.57±0.42) mm、(1.86±0.56) mm，撤机失败组分别为(0.98±0.26) mm、(1.24±0.31) mm、(1.38±0.39) mm，撤机成功组均比撤机失败组高，差异均有统计学意义(P<0.05)；SBT中DE对撤机成功不同时间节点均具有较高的特异性(90.20%、94.12%、96.08%)、敏感性(92.16%、96.08%、100.00%)与准确度(91.18%、95.10%、98.04%)，并在30 min时AUC值达到0.942 (P<0.05)；两组SBT中膈肌收缩速度在不同时间点(0 min、5 min、30 min)均明显上升(P<0.05)，不同时间点上，撤机成功组膈肌收缩速度分别为(1.42±0.38) cm/s、(1.54±0.42) cm/s、(1.63±0.59) cm/s，撤机失败组分别为(1.43±0.36) cm/s、(1.81±0.47) cm/s、(2.04±0.68) cm/s，撤机成功组均明显低于撤机失败组，差异均有统计学意义(P<0.05)；膈肌收缩速度在不同时间点对撤机成功均有一定特异性(52.94%、52.94%、60.78%)、敏感性（62.75%、58.82%、74.51%）与准确度(57.84%、55.88%、67.65%)，并在30 min时达到最高，AUC值为0.771 (P<0.05)。结论 机械通气的撤机预测可采取重症超声诊断方式，其中DE、膈肌收缩速度为评价撤机时机的重要指标，具有一定的敏感性、特异性和准确度。
      【关键词】 重症；超声诊断；机械通气；撤机
      【中图分类号】 R445.1 【文献标识码】 A 【文章编号】 1003—6350（2017）08—1265—03

Application of ultrasound diagnostic program in weaning severe patients from mechanical ventilation.
FANG Jun 1,LI Bing-bing 1, PAN Xiao-jie 2, LI Zhi-yan 1, ZHU Yan 3, ZHANG Yi 1, ZHAO Peng 1, WANG Hui-chi 1. Intensive Care Unit 1,Department of Ultrasound 2, Department of Acupuncture and Moxibustion 3, China National Petroleum Corporation CentralHospital, Langfang 065000, Hebei, CHINA
【Abstract】 Objective To investigate the clinical effect of ultrasound diagnostic program in weaning severe pa-tients from mechanical ventilation. Methods The clinical data of 98 patients on mechanical ventilation from July 2012to July 2015 in our hospital were retrospectively analyzed. According to the success or failure of weaning, the patientswere divided into the success group (47 cases) and the failure group (51 cases). The two groups of patients all under-went ultrasound monitoring and spontaneous breathing test (SBT). The changes of maximal right diaphragmatic displace-ment (DE) and diaphragmatic contraction velocity at different time points were compared, and the predictive value of nu-merical changes for weaning was analyzed. Results In SBT, the DE at different time points (0 min, 5 min, 30 min) ofthe two groups increased gradually (P<0.05). The DE of the success group were (1.05 ± 0.29) mm, (1.57 ± 0.42) mm,(1.86±0.56) mm respectively, as compared with (0.98±0.26) mm, (1.24±0.31) mm, (1.38±0.39) mm in the failure group(P<0.05). The DE in SBT had a high specificity (90.20%, 94.12%, 96.08% at 0 min, 5 min, 30 min, respectively), sensitivi-ty (92.16%, 96.08%, 100.00%) and accuracy (91.18%, 95.10%, 98.04%) for the success of weaning at different time, andAUC reached 0.942 at 30 min. The contraction velocity of diaphragm in SBT was significantly increased at different timepoints (0 min, 5 min, 30 min) (P<0.05). The diaphragmatic contraction velocity in the success group were (1.42±0.38) cm/s,·论 著·doi:10.3969/j.issn.1003-6350.2017.08.021基金项目：河北省廊坊市科技支撑计划（编号：2016013028）