评价膈肌浅快呼吸指数和膈肌增厚分数在机械通气撤机中的诊断价值

doi:10.3969/j.issn.1002-1949.2018.05.003

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摘要目的评价膈肌浅快呼吸指数(D-RSBI)和膈肌增厚分数(DTF)在机械通气撤机中的诊断价值。方法选择2017-03~2017-09期间武汉大学附属中南医院重症医学科接受机械通气时间>48 h的患者，在患者进行T管自主呼吸试验（SBT）期间，用床旁超声评估患者的膈肌功能并记录相关膈肌指标，包括膈肌位移（DD）、吸气末膈肌厚度（DTei）以及呼气末膈肌厚度(DTee)，同时记录患者撤机试验的结果，计算浅快呼吸指数（RSBI）、D-RSBI、DTF及其他生理参数。使用受试者工作特征曲线(ROC)评价D-RSBI和DTF在机械通气撤机中的预测价值。〖HTH〗结果〓〖HTSS〗共纳入48例接受机械通气>48 h并计划进行SBT的患者，其中撤机成功的患者29例（60.4%），撤机失败19例(39.6%)中，3例（6.25%）患者在进行SBT期间重新接受MV,8例（16.7%）患者在拔管后48 h内再次进行气管插管，8例（16.7%）患者在拔管后48 h内需接受无创通气支持。D-RSBI的ROC曲线下面积为0.848，特异度和敏感度分别为76.9%和85.2%(P<0.05)；DTF的ROC曲线下面积为0.894，特异度和敏感度分别为80.2%和89.7%(P<0.05)。结论 DTF比D-RSBI预测撤机结果更加准确。

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	王志力
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关键词 ：膈肌, 超声, 浅快呼吸指数（RSBI）, 膈肌增厚分数(DTF), 膈肌浅快呼吸指数(D-RSBI)

通讯作者: 李建国（1952-），男，博士，主任医师，教授，博士生导师，E-mail:drljg1817@163.com。

作者简介: 王志力（1991-),男，硕士，住院医师，E-mail:419111703@qq.com。

引用本文:

王志力，李建国，邓彬，李婉丽，蒋芳. 评价膈肌浅快呼吸指数和膈肌增厚分数在机械通气撤机中的诊断价值[J]. 中国急救医学, 2018, 38(5): 385-.
Wang Zhi-li, Li Jian-guo, Deng Bin, Li Wan-li, Jiang Fang. Diagnostic value of diaphragmatic rapid shallow breathing index(D-RSBI)and diaphragm thickening fraction(DTF)in weaning from mechanical ventilation. Chinese Journal of Critical Care Medicine, 2018, 38(5): 385-.

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http://www.cnemergency.org.cn/CN/10.3969/j.issn.1002-1949.2018.05.003 或 http://www.cnemergency.org.cn/CN/Y2018/V38/I5/385

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