| Objectives During the spontaneous breathing trial,the displacement of diaphragm and the variation of inferior vena cava in patients with mechanical ventilation in intensive care unit were monitored by ultrasound,and compared with the rapid shallow breathing index was compared to evaluate the predictive value of diaphragmatic displacement and inferior vena cava variability in patients with mechanical ventilation.Methods 42 patients were selected.These patients were treated with mechanical ventilation(> 48hs)in the ICU of the Affiliated Hospital of North China University of Technology.The selected patients have passed the screening test and plan to conduct the SBT.Before the weaning,the patient’s gender,age,hospitalization number and other general data are recorded.Before the SBT,APACHE II,tidal volume,p H,Pa O2/Fi O2,Pa O2,Pa CO2 and other general clinical data are recorded,and the RBSI is calculated by the formula.At the time node of 30 minutes in the SBT,the inferior vena cava variability and the right-hand displacement of the diaphragm were measured.According to the results of successful weaning,the patients were divided into the successful weaning group and the failure group.Perform statistical analysis on the data collected above.To evaluate the predictive degree of the combined measurement results of inferior vena cava variability and diaphragm displacement on the end of machine weaning for patients with mechanical ventilation.Results 1 A total of 42 patients met the criteria and were included.The main causes of respiratory failure required for tracheal intubation and invasive mechanical ventilation were 15 cases of severe pneumonia(36%)and 7 cases of heart failure(17%),4 cases(10%)of myocardial infarction,10 cases(24%)of Cerebrovascular accident,4 cases(10%)of acute exacerbation of chronic obstructive pulmonary disease,2 cases(5%)of pulmonary embolism.2 There were 29 patients in the success group and 13 patients in the failure group.After recording the parameters of the two groups,statistical analysis was carried out.There was no significant difference in gender,age and APACHE II score between the two groups(P>0.05).3 Comparison of clinical data before weaning: p H,Pa CO2,Pa O2,tidal volume,Pa O2/Fi O2 of the two groups of patients were not statistically significant(P>0.05).4 At the time node of 30 minutes in the SBT,the measured inferior vena cava variability in the successful group was significantly higher than that in the failure group(0.27 ± 0.06 vs 0.20 ± 0.05,P=0.003),and the successful diaphragm displacement group was significantly higher than the failure group(11.00 ± 1.67 vs 9.36 ± 1.83,P=0.007),the RSBI success group was significantly smaller than the failure group(47.22 ± 8.41 vs 54.64 ± 8.31,P=0.011),all three indicators were statistically different.5 ROC curve analysis of inferior vena cava variability,diaphragm displacement,and RBSI was performed.The result was that the optimal threshold of inferior vena cava variability was 0.23,the sensitivity was 72.41%,and the specificity was 84.62%,and AUC was 0.789.The optimal threshold for diaphragm displacement is 9.63 mm.the sensitivity is 86.21%,the specificity is 69.23%,and the AUC is 0.769.The optimal threshold of RBSI is 48.35,the specificity is 84.62%,and the AUC is 0.740.6 The combined prediction indexes of diaphragm displacement and inferior vena cava variability were calculated by logistic regression.The ROC curve of the combined prediction indexes was analyzed.The optimal threshold was 0.45,the sensitivity was 86.21%,the specificity was 76.92%,and the AUC was 0.851.7 According to the above analysis of ROC curve of RBSI,inferior vena cava variability,diaphragm displacement and joint indicators,the predictive value of the combined predictive indicators for the outcome of weaning is higher than the traditional single indicators of RBSI,inferior vena cava variability and diaphragm displacement Predicted value.Conclusions In the ICU,RBSI,diaphragm displacement,and inferior vena cava variability are instructive in predicting weaning.At the same time,the combined prediction index of diaphragm displacement and inferior vena cava variability can improve the accuracy of prediction.The above indicators can all be used as monitoring tools for the weaning forecast.Figure 4;Table 6;Reference 129... |
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