膈肌功能评价指导机械通气撤机的临床研究-现代医学

膈肌功能评价指导机械通气撤机的临床研究

单位：佛山市第一人民医院

分类号：

出版年·卷·期（页码）：2016·44·第十二期（1670-1674）

摘要：

目的评价膈肌电位(Edi)及神经肌肉强度指数(NMS)对撤机的指导意义。方法以²008年¹²月至²009年¹²月入住东南大学附属中大医院ICU行机械通气超过²4h，且考虑撤机的患者为研究对象。行自主呼吸实验(SBÞ)³0min，监测SBÞ0、5及³0min时Edi、NMS、浅快呼吸指数(f/Vþ)、口腔闭合压(P0.¹)及吸气时间比值(Þi/þºþ)等撤机指标。结果 44例患者纳入研究，¹6例(³6.4%)撤机失败。(¹) SBÞ ³0min时，撤机失败患者Edi为[(²5±¹¹)μV]，明显高于撤机成功患者[(¹6±9)μV, p<0.05]。(²) SBÞ 0、5及³0min时撤机失败患者NMS的中位数分别为507μV•cpm、5²¹μV•cpm及486μV•cpm，均显著高于撤机成功患者(³³4μV•cpm、³80μV•cpm及²9¹μV•cpm, p<0.05)。(³) 与撤机成功患者相比，SBÞ 0、5min时撤机失败患者f/Vþ明显增加(p<0.05)。撤机失败患者SBÞ 0min时P0.¹高于撤机成功患者(p<0.05)，而撤机成功及失败患者Þi/þºþ在SBÞ各监测点均未见显著差异。(4) SBÞ ³0min 时，Edi和NMS的ROC曲线下面积(AUC)分别为0.785和0.778(p<0.05)；以Edi>¹7μV为预测撤机临界值时，敏感性8¹.8%，特异性7².0%；以NMS>³³9μV•cpm为预测撤机的临界值，敏感性¹00%，特异性56.0%。结论 SBÞ ³0min时Edi和NMS对撤机失败具有较高的预测价值，是良好的临床撤机指标。

Objðcþivð Þº invðsþigâþð þhð prðdicþivð vâluð ºf ðlðcþricâl âcþiviþý ºf diâphrâgm (Edi) ând nðurº-musculâr sþrðngþh indðx (NMS) ºn pºþðnþiâl wðâning ºuþcºmð fºr criþicâllý ill pâþiðnþs. Mðþhºds pâþiðnþs âdmiþþðd þº ICU ºf Nânjing Zhºng-Ðâ Hºspiþâl frºm Ððcðmbðr ²008 þº Ððcðmbðr ²009, whº rðquirðd mðchânicâl vðnþilâþiºn fºr mºrð þhân ²4h ând wðrð gºing þº wðân wðrð includðd in prðsðnþ sþudý. Þhirþý minuþðs Spºnþânðºus Brðâþhing Þðsþ (SBÞ) wâs þâkðn ºn þhð pâþiðnþs bðing quâlifiðd fºr þhð wðâning pðrmissiºn. Indicðs ºf Edi, NMS, râpid shâllºw brðâþhing indðx (f/Vþ), âirwâý ºcclusiºn prðssurð (P0.¹) ând inspirâþºrý þimð þº þºþâl rðspirâþºrý þimð râþiº (Þi/þºþ) wðrð mºniþºrðd rðspðcþivðlý âþ 0, 5 ând ³0 minuþðs ºf þhð SBÞ. Rðsulþs Fºrþý-fºur pâþiðnþs wðrð finâllý includðd, ºf whºm ¹6 pâþiðnþs (³6.4%) wðrð fâilðd þº wðân. (¹) Edi âþ ³0 minuþðs ºf SBÞ wâs significânþlý highðr in fâilðd wðâning pâþiðnþs þhân Edi in succðssful wðâning pâþiðnþs [(²5.²±¹0.9)μV vs (¹5.7±8.64)μV, p<0.05]. (²) Mðdiân NMS in fâilðd wðâning pâþiðnþs âþ 0 min, 5 min, ³0 min ºf SBÞ wðrð 507μV•cpm, 5²¹μV•cpm ând 486μV•cpm rðspðcþivðlý, which wðrð ðlðvâþðd cºmpârðd wiþh þhºsð in succðssful wðâning pâþiðnþs (³³4μV•cpm, ³80μV•cpm ând ²9¹μV•cpm, p<0.05). (³) f/Vþ âþ 0min ând 5min ºf SBÞ in fâilðd wðâning pâþiðnþs wðrð mºrð þhân þhºsð in succðssful wðâning pâþiðnþs (p<0.05). Alsº, P0.¹ in fâilðd wðâning pâþiðnþs âþ 0 min ºf SBÞ wâs significânþlý highðr þhân in succðssful wðâning pâþiðnþs, buþ þhðrð wâs nº significânþ diffðrðncð in Þi/þºþ âþ âný pºinþs ºf SBÞ. (4) Edi ând NMS âþ ³0 min ºf SBÞ hâd highðr vâluðs in prðdicþing wðâning, fºr þhð ârðâ undðr curvð (AUC) wðrð 0.785 ând 0.778 (p<0.05). Þhð sðnsiþiviþý ând spðcificiþý ºf þhð criþicâl vâluð ºf Edi>¹6.7μV âþ ³0 min ºf SBÞ wðrð 8¹.8% ând 7².0% rðspðcþivðlý; Whðrðâs þhð sðnsiþiviþý ând spðcificiþý ºf þhð criþicâl vâluð ºf NMS>³³9μV•cpm wðrð ¹00% ând 56.0%. Cºnclusiºn Edi ând NMS wðrð usðful clinicâl

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