目的: 探讨分析床旁超声评估心脏舒张功能、膈肌功能及二者联合评估对重症医学科内行机械通气的患者撤机结果的预测能力。方法: 选取包头医学院第一附属医院重症医学科2022年12月至2023年9月住院的103例采用经口气管插管方式进行机械通气的患者。患者撤机前进行自主呼吸试验(spontaneous breathing trial, SBT),后根据SBT结果,分为撤机成功组(65例)与撤机失败组(38例),观察两组患者的膈肌功能指标及心脏舒张功能指标,分析膈肌功能及心脏舒张功能各参数统计学意义,并绘制ROC曲线,经过计算曲线下面积(AUC)对撤机结果进行评估分析。结果: 撤机成功组LVEF、DE、DTF、e′、三尖瓣E/A值及TAPSE均高于撤机失败组,撤机成功组呼吸频率、E/e′值及RVEDA/LVEDA小于撤机失败组,差异均具有统计学意义(P＜0.05)。撤机成功组中患者的二尖瓣E/A值与撤机失败组中患者的二尖瓣E/A值差异无统计学意义(P＞0.05)。DE、E/e′和TAPSE分别为膈肌功能及心脏舒张功能评估预测价值中AUC最大的3个参数,三者联合的AUC为0.904。结论: 床旁超声评估机械通气患者的心脏舒张功能及膈肌功能可较为准确地对机械通气患者撤机结果进行预测分析,二者联合评估有可能减少撤机失败事件的发生。
Objective: To explore and analyze the predictive ability of bedside ultrasound in evaluating cardiac diastolic function, diaphragmatic function and the combination of the two in the weaning results of patients undergoing mechanical ventilation in intensive care unit. Methods: A total of 103 patients with mechanical ventilation who were hospitalized in the intensive care unit of the First Affiliated Hospital of Baotou Medical College from December 2022 to September 2023 were selected. According to the results of spontaneous breathing trial (SBT) before weaning, they were divided into successful weaning group (65 patients) and weaning failure group (38 patients). The diaphragm function index and cardiac diastolic function index of the two groups were observed. The statistical significance of diaphragm function and cardiac diastolic function parameters was statistically analyzed, and the ROC curve was drawn. Results: The successful weaning group exhibited higher LVEF, DE, DTF, e', tricuspid E/A, and TAPSE values compared to the failed weaning group. The successful weaning group exhibited significantly lower values for respiratory rate, E/e', and RVEDA/LVEDA ratio than the failed weaning group (P＜0.05).There was no significant difference in mitral valve E/A value between the successful weaning group and the failed weaning group (P＞0.05). DE, E/e′and TAPSE were the three parameters with the largest AUC in the evaluation of diaphragmatic function and cardiac diastolic function, respectively, and the AUC of the combination of the three was 0.904. Conclusion: Bedside ultrasound assessment of cardiac diastolic function and diaphragmatic function in ICU patients with mechanical ventilation can accurately predict and analyze the weaning results of patients with mechanical ventilation, in order to reduce the occurrence of weaning failure events.
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