Value Of Ultrasound Detection Of Diaphragmatic Motion In The Evacuation Of Severe Patients

Objective To explore the application value of diaphragm motion detected by ultrasound in weaning severe patients,and to provide scientific guidance for successful weaning.Methods 96 patients with respiratory failure who were treated with mechanical ventilation for more than 48 hours from July 2016 to October 2018 and met the withdrawal criteria of spontaneous breathing test were randomly selected as the subjects,aged 18-71 years.According to the outcome of withdrawal,the patients were divided into successful withdrawal(57 cases,within 48 hours of withdrawal,spontaneous breathing,no need of mechanical ventilation again)and failed withdrawal(39 cases,Within 48 hours after weaning,it was impossible to maintain spontaneous breathing,and mechanical ventilation was used again for respiratory assistance.Statistical software SPSS24.0 was used to compare the changes of basic data and clinical characteristics,diaphragm movement,oxygenation index,shallow fast breathing index,as well as the predictive value of diaphragm movement detection for weaning,oxygenation index for weaning and shallow fast breathing index for weaning.Results(1)Basic data: The average age,sex structure,BMI and other indicators of the two groups were compared,and there was no significant difference(P < 0.05).(2)Clinical characteristics: There was no significant difference in clinical characteristics(smoking status,drug use,complications,APACHEII score,partial pressure of carbon dioxide,partial pressure of oxygen,etc.)between the two groups(P > 0.05).(3)The changes of oxygenation index,diaphragm mobility and shallow fast breathing index in 30 minutes of spontaneous breathing test: 30 minutes of spontaneous breathing test,the oxygen index and diaphragm mobility of successful weaning group were higher than those of failed weaning group(P < 0.05),and the shallow fast breathing index of successful weaning group was lower than that of failed weaning group(P < 0.05).(4)The predictive value of oxygenation index,diaphragm mobility and shallow fast breathing index on weaning: the critical value of shallow fast breathing index ROC was 53.45(times/min.L),the specificity and sensitivity of predicting weaning failure were 75.1% and 58.5% respectively;the critical value of diaphragm movement ROC was 11.15 mm,and the specificity and sensitivity of predicting weaning failure were 83.5% and 71.5% respectively;the critical value of oxygenation index ROC was 203 mmHg.The specificity and sensitivity of predicting weaning failure were 72.5% and 81.7% respectively,indicating that diaphragm motion(AUCROC=0.931)had the highest predictive value for weaning,followed by oxygenation index(AUCROC=0.743)and shallow fast breathing index(AUCROC=0.710).Conclusion The diaphragm movement,oxygenation index and shallow fast breathing index can effectively predict weaning outcomes in severe patients.Compared with oxygenation index and shallow fast breathing index,diaphragm movement has a higher predictive value.Therefore,diaphragm movement can be used as a sensitive guide for predicting weaning outcomes in severe patients.At the same time,it also shows super-score.Acoustic examination is simple,non-invasive and repeatable.It has the value of optimization and is worth using.