论文部分内容阅读
目的:探讨膈肌超声在心脏瓣膜置换术患者呼吸机撤机中的作用。方法:选取2019年12月至2021年2月在中国医学科学院阜外医院心外科接受心脏瓣膜置换术且接受机械通气时间≥48 h并已进入撤机前自主呼吸试验的103例患者为研究对象，根据患者的撤机结果将其分为撤机成功组（83例）和撤机失败组（20例）。通过超声技术测定患者的膈肌增厚率（DTF）和膈肌移动度（DE），并应用受试者工作特征（ROC）曲线评估DTF和DE用于预测呼吸机撤机结果的价值。结果:83例撤机成功组患者中男性患者为52例，女性患者为31例，年龄为（56.5±5.5）岁；20例撤机失败组患者男性患者为12例，女性患者为8例，平均年龄为（57.3±6.2）岁。撤机成功组患者的左侧DTF、右侧DTF、左侧DE、右侧DE分别为（39.0±17.8）%、（57.7±1.2）%、（11.9±4.3）mm、（18.5±1.4）mm，均高于撤机失败组患者，分别为（18.1±4.5）%、（19.9±2.3）%、（6.2±2.8）mm、（11.9±1.5）mm，差异均有统计学意义（均n P<0.05）。ROC曲线分析显示，撤机成功患者左右侧DTF的最佳临界值分别为61%和88%，敏感性分别为90.46%和96.07%，特异性分别为87.83%和89.67%；左右侧DE的最佳临界值分别为11.3 mm和12.7 mm，敏感性分别为81.38%和85.56%，特异性分别为80.24%和87.23%。n 结论:膈肌超声可较准确地预测心脏瓣膜置换术患者呼吸机撤机的结局，具有较好的临床应用价值。“,”Objective:To explore the role of diaphragm ultrasound in guiding the successful weaning of ventilators in patients undergoing heart valve replacement.Methods:Prospectively selected 103 patients who received heart valve replacement in the Department of Cardiac Surgery, Fuwai Hospital of the Chinese Academy of Medical Sciences from December 2019 to February 2021 were selected, who have received mechanical ventilation for ≥48 h and have entered the pre-weaning spontaneous breathing test. The patients were divided into a successful weaning group (n n=83) and failed weaning group (n n=20) according to the patient′s weaning result. Receiver operating characteristic (ROC) curve was used to evaluate the value of diaphragm thickening rate and diaphragmatic excursion to predict the result of ventilator weaning.n Results:Among 83 patients in the successful weaning group, 52 were male patients and 31 were female patients, with an average age of (56.5±5.5) years; 20 patients in the failed weaning group included 12 male patients and 8 female patients, with an average The age is (57.3±6.2) years old.The left DTF, right DTF, left DE, and right DE of the patients in the successfully weaned group were (39.0±17.8)%, (57.7±1.2)%, (11.9±4.3) mm, (18.5±1.4) mm, respectively, which were higher than those in the weaning failure group (18.1±4.5)%, (19.9±2.3)%, (6.2±2.8) mm, (11.9±1.5) mm, respectively. And the differences were statistically significant (all n P<0.05). ROC curve analysis showed that the best cut-off values, the sensitivity and the specificity for the thickening rate of the left diaphragms of patients with successful weaning were 61%, 90.46% and 87.83%, respectively; while the best cut-off values, the sensitivity and the specificity for the thickening rate of the right diaphragms of patients with successful weaning were 88%, 96.07% and 89.67%, respectively. The optimal cut-off values, the sensitivity and the specificity of mobility of the left right diaphragms of patients are 11.3 mm, 81.38% and 80.24%, respectively; while the optimal cut-off values, the sensitivity and the specificity of right diaphragms of patients were 12.7 mm, 87.23% and 85.56%, respectively.n Conclusion:Diaphragm ultrasound can more accurately predict the outcome of ventilator weaning in patients undergoing heart valve replacement surgery, and it has good clinical application value.