Value of diaphragm ultrasound score scale in predicting mechanical ventilator withdrawal

LIU Jinyu; WANG Qiang; WANG Xiaomi; GONG Decheng; ZHANG Lei

doi:10.16245/j.cnki.issn1008-6978.2020.01.014

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Value of diaphragm ultrasound score scale in predicting mechanical ventilator withdrawal

更新时间：2021-10-08

- Value of diaphragm ultrasound score scale in predicting mechanical ventilator withdrawal
- Journal of Clinical Ultrasound in Medicine Vol. 22, Issue 1, Pages: 38-41(2020)
- 作者机构：
  
  黄河三门峡医院急诊科
- 作者简介：
- 基金信息：
- DOI：10.16245/j.cnki.issn1008-6978.2020.01.014
  CLC： R459.7;R445.1
- Published：2020，
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[1]刘晋豫,王强,汪晓蜜,巩德成,张磊.膈肌超声评分预测机械通气撤机的价值探讨[J].临床超声医学杂志,2020,22(01):38-41.

LIU Jinyu, WANG Qiang, WANG Xiaomi, et al. Value of diaphragm ultrasound score scale in predicting mechanical ventilator withdrawal. [J]. Journal of Clinical Ultrasound in Medicine 22(1):38-41(2020)
[1]刘晋豫,王强,汪晓蜜,巩德成,张磊.膈肌超声评分预测机械通气撤机的价值探讨[J].临床超声医学杂志,2020,22(01):38-41. DOI： 10.16245/j.cnki.issn1008-6978.2020.01.014.

LIU Jinyu, WANG Qiang, WANG Xiaomi, et al. Value of diaphragm ultrasound score scale in predicting mechanical ventilator withdrawal. [J]. Journal of Clinical Ultrasound in Medicine 22(1):38-41(2020) DOI： 10.16245/j.cnki.issn1008-6978.2020.01.014.

摘要

目的探讨膈肌超声评分在预测机械通气患者成功撤机中的价值。方法对64例机械通气患者行床旁超声检查

记录其自主呼吸试验时膈肌厚度的变化、双侧膈肌的运动幅度、膈肌相关的浅快呼吸指数（D-RSBI）。根据患者撤机是否成功分为撤机成功组39例和撤机失败组25例。绘制受试者工作特征（ROC）曲线分析自主呼吸试验时膈肌增厚率、膈肌运动幅度、D-RSBI对撤机失败的预测价值

根据最佳临界值将相关的连续性变量转化为二分类变量

进行多因素Logistic回归分析

建立膈肌超声评分系统

预测患者撤机失败率。结果撤机成功组和撤机失败组膈肌增厚率、膈肌运动幅度、D-RSBI比较差异均有统计学意义（均P<0.05）。ROC曲线分析显示撤机成功患者膈肌增厚率的最佳临界值53%

敏感性89.6%

特异性45.4%

约登指数0.283;膈肌运动幅度的最佳临界值11.8 mm

敏感性62.3%

特异性79.4%

约登指数0.413;D-RSBI的最佳临界值1.7 mm·min/n

敏感性58.6%

特异性81.3%

约登指数0.312。膈肌增厚率≥53%、膈肌运动幅度≥11.8 mm及D-RSBI≤1.7 mm·min/n均是呼吸机撤机失败的独立影响因素（OR=5.982、2.966、4.356）。根据膈肌超声评分情况将25例撤机失败患者分为低危8例（0～2分）、中危11例（3～6分）和高危6例（7～8分）

其撤机失败发生率分别为11.4%、52.6%、89.7%。结论膈肌超声评分可较准确地预测机械通气患者撤机结局

具有较好的临床应用价值。

Abstract

ObjectiveTo explore the value of diaphragm ultrasound score in predicting the success of mechanical ventilation withdrawal.MethodsSixty-four mechanically ventilated patients underwent bedside ultrasound

the changes of diaphragm thickness and bilateral diaphragmatic motion amplitudes during the spontaneous breathing trial（SBT）

and diaphragmatic-related shallow fast breathing index（D-RSBI）were recorded.According to whether the patients were successfully offline

they were divided into the successful group（39 cases）and the failed group（25 cases）.The ROC curve was drawn to analyze the diaphragmatic thickness rate

diaphragmatic motion amplitude and D-RSBI for predicting offline failure during SBT.According tothebestcriticalvalue

the related continuous variables were transformed into binary variables

the multivariate logistic regression analysis was carried out

the diaphragm ultrasound score table was established and the probability of failed withdrawal was predicted.ResultsThe differences in diaphragmatic thickening rate

diaphragmatic motion amplitude and D-RSBI between the successful and failed group were statistically significant（all P<0.05）. ROC curve showed that the optimal cutoff value of diaphragmatic thickening rate in successful group was 53%

the sensitivity was 89.6%

specificity was 45.4%

and Youden index was 0.283.Optimal cutoff value of diaphragmatic motion amplitude was 11.8 mm

the sensitivity was 62.3 %

specificity was79.4%

Youden index was 0.413.Optimal cutoff value of D-RSBI was 1.7 mm·min/n

the sensitivity was 58.6%

specificity was81.3%

and Youden index was 0.312.Diaphragm thickness rate

diaphragmatic motion amplitude and D-RSBI were independent risk factors for ventilator failure（OR=5.982

2.966

4.356）.According to the diaphragm ultrasound score table

25 patients were divided into 8 cases with low-risk（0～2 points）

11 cases with medium risk（3～6 points）and 6 cases with high-risk group（7～8 points）. The rate of failure to withdrawl were 11.4%

52.6% and 89.7% respectively.ConclusionDiaphragm ultrasound score table can accurately predict the probability of successful offline of mechanical ventilation.

关键词

超声检查膈肌撤机隔肌功能障碍机械通气

Keywords

UltrasonographyDiaphragmOfflineDiaphragm dysfunctionMechanical ventilation

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