膈肌超声预测重症肺炎患者的撤机模式研究
PDF下载 (73)于 钦,胡占升.膈肌超声预测重症肺炎患者的撤机模式研究[J].宁波大学学报(理工版),2025,38(5):113-120.DOI:10.20098/j.cnki.1001-5132.2025.0315
YU Qin,HU Zhansheng.Diaphragmatic ultrasound predicts weaning in severe pneumonia patients[J].Journal of Ningbo University(Natural Science & Engineering Edition),2025,38(5):113-120.DOI:10.20098/j.cnki.1001-5132.2025.0315
| Title: | Diaphragmatic ultrasound predicts weaning in severe pneumonia patients |
| 作者: | 于 钦, 胡占升 |
| Author(s): | YU Qin, HU Zhansheng |
| 关键词: | 重症肺炎; 机械通气; 膈肌超声; 预测模型 |
| Keywords: | severe pneumonia; mechanical ventilation; diaphragmatic ultrasound; predictive model |
| 分类号: | R619 |
| DOI: | 10.20098/j.cnki.1001-5132.2025.0315 |
| 文献标识码: | A |
| 摘要: | 探讨各指标联合膈肌超声对重症肺炎患者撤机的指导价值，并构建撤机成功的预测模型。以2023—2024年住院期间确诊为重症肺炎且需机械通气的73例患者为研究对象，收集患者一般性资料，观察浅快呼吸指数（Rapid Shallow Breathing Index，RSBI）、降钙素原（Procalcitonin，PCT）、动脉血氧分压（Blood Oxygen Partial Pressure，PaO2）、呼吸速率（Respiratory Rate，RR）等临床指标。自主呼吸试验（Spontaneous Breathing Trial，SBT）30min时，通过超声评估膈肌功能，依据撤机结局分为撤机成功组与失败组。运用Logistic回归分析患者撤机的影响因素，进而构建撤机成功预测模型，并利用受测者工作特征曲线（Receiver Operating Characteristic，ROC）分析模型预测价值。结果表明：撤机成功组的膈肌增厚比（Diaphragmatic Thickening Ratio，DTR）与膈肌移动度（Diaphragmatic Excursion，DE）均高于失败组（P<0.05）；RSBI、PCT、DTR、DE、机械通气时间（t）均为撤机的影响因素（P<0.05）；Logistic回归拟合重症肺炎患者撤机预测模型为 ，该模型拟合优度检验χ2=0.653，P>0.05；ROC曲线下面积为0.965（95%CI：0.925~1.000），敏感度与特异度分别为96.4%和86.7%，约登指数为0.831。证明多指标联合构建撤机成功预测模型对重症肺炎患者撤机具有指导意义，可为临床判断撤机时机提供可靠参考。 |
| Abstract: | This study aims to analyze the predictive value of
diaphragmatic ultrasound in combination with other clinical indicators for
weaning from mechanical ventilation in patients with severe pneumonia, and to
construct a predictive model for successful weaning. A prospective study was
conducted on 73 patients diagnosed with severe pneumonia requiring mechanical
ventilation from 2023 to 2024. General clinical data were collected, and
clinical indicators such as the Rapid Shallow Breathing Index (RSBI),
Procalcitonin (PCT), Blood Oxygen Partial
Pressure (PaO2), and respiratory rate were observed.
Diaphragmatic function was assessed using ultrasound during a 30 minute
Spontaneous Breathing Trial (SBT). Patients were divided into successful and
failed weaning groups based on the outcome of the weaning. Logistic regression
analysis was used to identify factors influencing weaning in patients with
severe pneumonia and to construct a predictive model for the successful
weaning. The predictive value of the model was analyzed using the Receiver
Operating Characteristic (ROC) curve. The successful weaning group had
significantly higher Diaphragmatic Thickening Ratio (DTR) and Diaphragmatic
Excursion (DE) as compared to the failed weaning group, P<0.05. Mechanical ventilation duration, PCT, RSBI, DTR, and DE
were identified as factors influencing weaning in patients with severe
pneumonia (P<0.05). The logistic
regression model for predicting weaning success was formulated as follows:
. The model’s
goodness-of-fit test showed χ²=0.653, P>0.05. The Area Under the Curve
(AUC) was 0.965 (95% CI: 0.925–1.000), with a
sensitivity of 96.4% and specificity of 86.7%, and a Youden index of 0.831. The results
demonstrated that this predictive model incorporating multiple indicators
provides significant guidance for weaning in patients with severe pneumonia,
and it can provide a reliable
reference for clinical judgment on the timing of weaning from mechanical
ventilation. |
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| 备注/Memo: | 收稿日期：2025−03−20 宁波大学学报（理工版）网址：http://journallg.nbu.edu.cn/ 基金项目：辽宁省教育厅基本科研项目（JYTMS20231728） 第一作者：于 钦，硕士研究生，主要研究方向为机械通气及膈肌超声相关领域。E-mail: yuqin19980220@163.com *通信作者：胡占升，主任医师，主要研究方向为机械通气及膈肌超声相关领域。E-mail: 1341309612@qq.com 宁波大学学报（理工版）网址：http://journallg.nbu.edu.cn/ |
