Clinical Study On The Application Value Of Diaphragm Ultrasound In The Diagnosis Of ICU Acquired Weakness

Objective:To explore the clinical value of diaphragmatic ultrasound in the diagnosis of ICU acquired weakness.Methods:Forty-eight patients who met the inclusion and exclusion criteria in EICU of the First Affiliated Hospital of Kunming Medical University from January 2018 to January 2019 were selected.The patients were divided into two groups according to ventilation mode:26 cases of patients with mechanical ventilation group;22 cases of patients with non-mechanical ventilation group.The pulmonary LUS score,diaphragm thickness,diaphragm movement and diaphragmatic contraction(DTF)were measured by bedside ultrasonography on the first,third and seventh days after staying in ICU.At the same time,the patient's ventilation mode,mechanical ventilation parameters and other related values were recorded.Patients were scored APACHE ? score,SOFA score,MRC score,patient's age,gender,BMI,total time of ICU stay,offline time,etc.,and the data were statistically analyzed.Results:1?There was a statistically significant D1 and D7 of the diaphragm thickness at the end of the exhalation in patients with mechanical ventilation(D1,D3,D7)?and there was no statistically significant comparison between the remaining time points.There were statistically significant differences in the contraction of diaphragm muscle between the three groups(P<0.05).Correlation analysis of diaphragmatic mobility,contraction,inspiratory diaphragm thickness,end-tidal thickness and APACHE ? score in mechanical ventilation patients,r values were-0.06,-0.29,-0.18,-0.33,respectively,P values were 0.573,0.023,0.096,0.001.The correlation analysis of diaphragm mobility,contractility,end-inspiratory diaphragm thickness,end-expiratory thickness and SOFA score showed that R values were-0.08,-0.23,-0.18,-0.16,P values were 0.426,0.032,0.080 and 0.128,respectively.2?There was no significant difference in end-inspiratory diaphragm thickness between two groups at different time points(D1,D3,D7)in non-mechanical ventilation patients;The thickness of end-expiratory diaphragm,diaphragm mobility and diaphragm contractility D1 and D3,D1 and D7 days had statistical significance(P<0.05),but D3 and D7 had no statistical significance.The correlation analysis of diaphragm mobility,contractility,end-inspiratory diaphragm thickness,end-expiratory thickness and APACHEE ? score in non-mechanical ventilation patients showed that R values were 0.06,-0.01,0.28 and 0.26,P values were 0.742,0.965,0.133 and 0.170,respectively.The correlation analysis of diaphragm mobility,contractility,end-inspiratory diaphragm thickness,end-expiratory thickness and SOFA score showed that R values were-0.25,-0.02,0.13 and 0.15,P values were 0.181,0.915,0.503 and 0.441,respectively.3?After comparing the parameters of the diaphragm between the mechanical ventilation patients and the non-mechanical ventilation patients on the seventh day,it was found that there was no significant difference in the thickness of the end-inspiratory diaphragm,the mobility of the diaphragm and the contractility of the diaphragm,but there was significant difference in the thickness of the end-expiratory diaphragm between the two groups(P<0.001).4?ROC curve analysis display:In patients with mechanical ventilation,the area AUC was 0.84,the sensitivity was 0.86,and the specificity was 0.80,P=0.001 under the curve of diaphragmatic ultrasound in the diagnosis of shrinkage in ICU acquired weakness.The area AUC was 0.80,the sensitivity was 0.71,and the specificity was 0.74,P=0.019 under the curve of the thickness of the diaphragmatic muscle at the end of the exhalation.In the non-mechanical ventilation patients,the area under the curve of the contraction degree of the acquired ICU in the diagnosis of ICU was 0.62,P=0.569.The area under the curve of the end-expiratory muscle thickness was 0.57,P=0.732.Conclusions:1?In mechanical ventilation patients in the ICU,we can use the diaphragmatic ultrasound to make early prediction and diagnosis of ICU acquired weakness.2?In all diaphragmatic ultrasound indexes,the thickness of the diaphragmatic muscle and the degree of diaphragmatic contraction(DTF)were the most sensitive indicators.