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-  2018 

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

DOI: doi:10.7507/1671-6205.201712001

Keywords: 慢性阻塞性肺疾病, 呼吸浅快指数, 机械通气, 撤机

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Abstract:

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( R 2=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

References

[1]  2. Girard TD, Alhazzani W, Kress JP, et al. An Official American Thoracic Society/American College of Chest Physicians Clinical Practice Guideline: Liberation from Mechanical Ventilation in Critically Ill Adults. Rehabilitation Protocols, Ventilator Liberation Protocols, and Cuff Leak Tests. Am J Respir Crit Care Med, 2017, 195(1): 120-133.
[2]  4. Karthika M, Al Enezi FA, Pillai LV, et al. Rapid shallow breathing index. Ann Thorac Med, 2016, 11(3): 167-176.
[3]  5. Lee KH, Hui KP, Chan TB, et al. Rapid shallow breathing (frequency- tidal volume ratio) did not predict extubation outcome. Chest, 1994, 105: 540-543.
[4]  6. Huang CT, Yu CJ. Conventional weaning parameters do not predict extubation outcome in intubated subjects requiring prolonged mechanical ventilation. Respir Care, 2013, 58: 1307-1314.
[5]  7. Savi A, Teixeira C, Silva JM, et al. Weaning predictors do not predict extubation failure in simple-to-wean patients. J Crit Care, 2012, 27(2): 221.
[6]  8. Schellekens WJ, van Hees HW, Doorduin J, et al. Strategies to optimize respiratory muscle function in ICU patients. Crit Care, 2016, 20(1): 103.
[7]  11. Vogelmeier CF, Criner GJ, Martinez FJ, et al. Global Strategy for the Diagnosis, Management, and Prevention of Chronic Obstructive Lung Disease 2017 Report. GOLD Executive Summary. Am J Respir Crit Care Med, 2017, 195(5): 557-582.
[8]  12. Boles JM, Bion J, Connors A, et al. Weaning from mechanical ventilation. Eur Respir J, 2007, 29(5): 1033-1056.
[9]  13. Francis CA, Hoffer JA, Reynolds S. Ultrasonographic Evaluation of Diaphragm Thickness During Mechanical Ventilation in Intensive Care Patients. Am J Crit Care, 2016, 25(1): e1-8.
[10]  21. DiNino E, Gartman E J, Sethi J M, et al. Diaphragm ultrasound as a predictor of successful extubation from mechanical ventilation. Thorax, 2013, 69(5): 431-435.
[11]  1. Burns KEA, Soliman I, Adhikari NKJ, et al. Trials directly comparing alternative spontaneous breathing trial techniques: a systematic review and meta-analysis. Crit Care, 2017, 21(1): 127.
[12]  3. Thille AW, Harrois A, Schortgen F, Brun-Buisson C, Brochard L. Outcomes of extubation failure in medical intensive care unit patients. Crit Care Med, 2011, 39(12): 2612-2618.
[13]  9. Capdevila X, Perrigault PF, Ramonatxo M, Roustan JP, Peray P, d’Athis F, Prefaut C. Changes in breathing pattern and respiratory muscle performance parameters during difficult weaning. Crit Care Med, 1998, 26(1): 79-87.
[14]  10. Heunks LM, van der Hoeven JG. Clinical review: the ABC of weaning failure—a structured approach. Crit Care. 2010;14(6): 245.
[15]  14. 李敏, 黄绍光, 汤葳, 等. 呼吸功作为慢性阻塞性肺病患者撤机指标的评价. 中华急诊医学杂志, 2003, 12(12): 836-838.
[16]  15. Tobin MJ, Laghi F, Brochard L. Role of the respiratory muscles in acute respiratory failure of COPD: lessons from weaning failure. J Appl Physiol (1985), 2009, 107(3): 962-970.
[17]  16. 丁立君, 阎锡新, 宋贝贝, 等. 慢性阻塞性肺疾病模型大鼠膈肌功能的实验研究. 国际呼吸杂志, 2009, 29(15): 905-908.
[18]  17. 陈重泽, 连细华, 杨如容, 等. 超声研究膈肌移动度与对合角度对 COPD 病情初步判定. 中国超声医学杂志, 2016, 32(1): 34-36.
[19]  18. Lerolle N, Diehl JL. Ultrasonographic evaluation of diaphragmatic function. Crit Care Med, 2011, 39(12): 2760-2761.
[20]  19. DiNino E, Gartman EJ, Sethi JM, et al. Diaphragm ultrasound as a predictor of successful extubation from mechanical ventilation. Thorax, 2014, 69(5): 423-427.(这个对).
[21]  20. Jiang JR, Tsai TH, Jerng JS, et al. Ultrasonographic evaluation of liver/spleen movements and extubation outcome. Chest, 2004, 126(1): 179-185.
[22]  22. Ferrari G, De Filippi G, Elia F, et al. Diaphragm ultrasound as a new index of discontinuation from mechanical ventilation. Crit Ultrasound J, 2014, 6(1): 8.
[23]  23. Chao DC, Scheinhorn DJ. Determining the best threshold of rapid shallow breathing index in a therapist-implemented patient-specific weaning protocol. Respir Care, 2007, 52(2): 159-165.
[24]  24. Smargiassi A, Inchingolo R, Tagliaboschi L, et al. Ultrasonographic assessment of the diaphragm in chronic obstructive pulmonary disease patients: relationships with pulmonary function and the influence of body composition - a pilot study. Respiration, 2014, 87(5): 364-371.

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