超声监测下腔静脉变异度对心功能不全患者困难撤机的预测价值被引量：15

Predictive value of inferior vena cava variability for difficult weaning in patients with cardiac dysfunction under ultrasonic monitor

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摘要目的探讨超声监测下腔静脉变异度(△D_(IVC))对心功能不全患者困难撤机的预测价值。方法选取我院重症医学科中存在心功能不全的机械通气患者99例,按照自主呼吸试验结果将其分为成功撤机组59例和困难撤机组40例。比较两组患者自主呼吸试验过程中△D_(IVC)、呼吸浅快指数(RBSI)。绘制受试者工作特征(ROC)曲线分别评价二者对心功能不全患者困难撤机的预测价值。结果成功撤机组△D_(IVC)为0.28±0.07,困难撤机组为0.19±0.04,两组比较差异有统计学意义(P<0.05)。△D_(IVC)预测心功能不全患者困难撤机的ROC曲线下面积为0.839(95%可信区间:0.752~0.925),以△D_(IVC)≤0.25为截断值预测心功能不全患者困难撤机的敏感性为69.5%,特异性为94.7%。成功撤机组RBSI为(66.9±27.2)次·min^(-1)·L^(-1),困难撤机组为(94.8±31.7)次·min^(-1)·L^(-1),两组比较差异有统计学意义(P<0.05),RBSI预测心功能不全患者困难撤机的ROC曲线下面积为0.816(95%可信区间:0.727~0.905),以RBSI>105次·min^(-1)·L^(-1)为截断值预测心功能不全患者困难撤机的敏感性为91.7%,特异性为35.2%。结论超声监测△D_(IVC)对预测心功能不全患者困难撤机具有一定的指导价值,其诊断特异性较高。 Objective To evaluate the predictive value of inferior vena cava variability（DTVC）for difficult weaning in patients with cardiac dysfuncion under ultrasonic monitor. Methods Ninety-nine mechanical ventilation patients with cardiac dysfuncion were enrolled. According to the spontaneous breath test result,they were divided into successful weaning group（n=59） and difficult weaning group（n=40）. During the spontaneous breath test,the DIVC and rapid breathing shallow index（RBSI） of two groups were recorded and compared. ROC curve was used to evaluate the predictive value. Results The△DIVC of successful weaning group was 0.28 ±0.07, the△DIVC of difficult weaning group was 0.19 ±0.04, there was significant difference between two groups （P〈0.05）.AUC for △DIVC to predict difficult weaning was 0.839（95%CI：0.752-0.925）,the cut-off value gave△DIVC≤0.25 with a sensitivity of 69.5%and a specificity of 94.7%. The RBSI of successful weaning group was（66.9±27.2）beats·min-1·L-1, the RBSI of difficult weaning group was（94.8±31.7）beats·min-1·L-1, there was significant difference between two groups（P〈0.05）. AUC for RBSI to predict difficult weaning was 0 . 816（95%CI：0 . 727-0 . 905）. There was a sensitivity of 91 . 7% and a specificity of 35.2%for determining difficult weaning when RBSI was〉105 beats·min-1·L-1. Conclusion The assessment of DIVC under ultrasonic monitor is helpful to predict difficult weaning in patients with cardiac dysfuncion,and it has high specificity.

作者步涨潘纯王俊徐杉

机构地区苏州大学附属第一医院重症医学科东南大学附属中大医院重症医学科

出处《临床超声医学杂志》 2017年第6期371-374,共4页 Journal of Clinical Ultrasound in Medicine

基金国家自然科学基金项目(81300043)

关键词超声检查心功能不全下腔静脉变异度困难撤机 Ultrasonography Cardiac dysfuncion Variation of inferior vena cava Difficult weaning

分类号 R445.1 [医药卫生—影像医学与核医学]

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