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中华肺部疾病杂志(电子版)

中华肺部疾病杂志(电子版) ›› 2023, Vol. 16 ›› Issue (06) : 799 -803. doi: 10.3877/cma.j.issn.1674-6902.2023.06.011

论著

心脏超声参数对AECOPD呼吸衰竭机械通气撤机及预后的关系
李莉, 向丽丽, 庹菲†()   
  1. 410007　长沙，湖南中医药大学第一附属医院超声影像科
  • 收稿日期:2023-11-18 出版日期:2023-12-25
  • 通信作者: 庹菲
  • 基金资助:
    湖南省自然科学基金(2020JJ5918)

Relationship between cardiac ultrasound parameters and extubation outcome in AECOPD patients with respiratory failure

Li Li, Lili Xiang, Fei Tou†()   

  1. Department of Ultrasonography, The First Affiliated Hospital of Hunan University of Traditional Chinese Medicine, Changsha, Hunan 410007, China
  • Received:2023-11-18 Published:2023-12-25
  • Corresponding author: Fei Tou
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李莉, 向丽丽, 庹菲. 心脏超声参数对AECOPD呼吸衰竭机械通气撤机及预后的关系[J]. 中华肺部疾病杂志(电子版), 2023, 16(06): 799-803.

Li Li, Lili Xiang, Fei Tou. Relationship between cardiac ultrasound parameters and extubation outcome in AECOPD patients with respiratory failure[J]. Chinese Journal of Lung Diseases(Electronic Edition), 2023, 16(06): 799-803.

目的

分析心脏超声参数与慢性阻塞性肺疾病急性加重(acute exacerbation of chronic obstructive pulmonary disease, AECOPD)并发呼吸衰竭患者机械通气撤机结局的关系。

方法

选2020年4月至2023年4月于湖南中医药大学第一附属医院接受有创机械通气治疗的AECOPD并发呼吸衰竭患者64例，收集患者的病历资料，于撤机前行心肺超声检查，根据撤机结局分撤机成功为对照组和撤机失败为观察组，寻找撤机失败的危险因素，分析心脏超声参数对撤机结局的预测。

结果

64例患者中撤机成功45例(70.31%)，撤机失败19例(29.69%)。观察组和对照组的浅快呼吸指数分别为(92.31±7.81)vs.(78.26±9.63)次/min/L、肺部超声评分分别为(19.28±3.31)vs.(17.15±3.04)分、舒张早期左房室瓣血流速度/左房室瓣环速度(V1/V3)分别为(10.29±1.58)vs.(8.16±1.39)，观察组高于对照组(P<0.05)。浅快呼吸指数(OR＝3.518，95%CI：1.671～7.409)、肺部超声评分(OR＝3.688，95%CI：1.751～7.766)、V1/V3(OR＝3.651，95%CI：1.734～7.689)为AECOPD并发呼吸衰竭患者撤机失败的影响因素(P<0.05)。心脏超声参数预测AECOPD并发呼吸衰竭患者撤机失败的灵敏度为0.813、特异度为0.771、曲线下面积为0.844。

结论

心脏超声参数对AECOPD并发呼吸衰竭患者的撤机结局相关，舒张早期左房室瓣血流速度与左房室瓣环速度比值升高可增加撤机失败风险。

关键词: 急性加重期，肺疾病，慢性阻塞性, 呼吸衰竭, 心脏超声参数, 撤机结局
Objective

To investigate the relationship between echocardiographic parameters and the outcome of mechanical ventilation weaning in patients with AECOPD complicated with respiratory failure.

Methods

A total of 64 patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) complicated by respiratory failure, who underwent invasive mechanical ventilation treatment at the First Affiliated Hospital of Hunan University of Chinese Medicine from April 2020 to April 2023, were included in this study. Medical records of the patients were collected, and cardiovascular and pulmonary ultrasound examinations were performed before extubation. Based on the extubation outcome, the patients were divided into a control group (successful extubation) and an observation group (failed extubation). Risk factors for extubation failure were screened, and the predictive value of cardiac ultrasound parameters for extubation outcome was analyzed.

Results

Out of the 64 patients, 45 (70.31%) were successfully extubated while 19 (29.69%) failed. The observation group had higher Shallow Fast Breathing Index [(92.31±7.81) vs. (78.26±9.63) breaths/min/L], Lung Ultrasound Score [(19.28±3.31) vs. (17.15±3.04) points], and Early Diastolic Mitral Annular Velocity to Early Diastolic Mitral Flow Velocity (V1/V3) [(10.29±1.58) vs. (8.16±1.39)] than the control group (P<0.05). Shallow Fast Breathing Index (OR=3.518, 95%CI: 1.671-7.409), Lung Ultrasound Score (OR=3.688, 95%CI: 1.751-7.766), and V1/V3 (OR=3.651, 95%CI: 1.734-7.689) were identified as risk factors for extubation failure in AECOPD patients with respiratory failure (P<0.05). The sensitivity, specificity, and area under the curve of cardiac ultrasound parameters in predicting extubation failure were 0.813, 0.771, and 0.844, respectively. The mortality rate in the control group was 0.00%, which was significantly lower than the 26.32% in the observation group (P<0.05).

Conclusion

Cardiac ultrasound parameters are associated with the weaning outcome of patients with AECOPD complicated by respiratory failure, and an increase in the ratio of early diastolic mitral inflow velocity to early diastolic mitral annular velocity is associated with an increased risk of weaning failure.

Key words: Acute exacerbation of chronic obstructive pulmonary disease, Respiratory failure, Cardiac ultrasound parameters, Withdrawal outcome
表1 两组AECOPD患者的一般资料结果比较[n(%)]
临床资料 对照组(n＝45) 观察组(n＝19) χ2/t P值
APACHE Ⅱ评分(分) 11.78±1.59 11.86±1.64 0.217 0.828
心率(次/min) 91.42±5.34 90.08±5.19 1.101 0.274
呼吸频率(次/min) 22.81±4.53 22.95±4.36 0.136 0.892
pH 7.42±0.09 7.41±0.10 0.393 0.697
HCO3－(mmol/L) 26.51±1.17 27.02±1.35 1.521 0.133
PaO2(mmHg) 88.16±8.52 87.13±7.29 0.546 0.586
PaCO2(mmHg) 35.72±5.61 34.97±5.34 0.590 0.557
呼吸指数(次/min/L) 78.26±9.63 92.31±7.81 6.662 0.001
肺部超声评分(分) 17.15±3.04 19.28±3.31 2.978 0.004
左心室后壁厚度(mm) 9.25±1.13 9.22±1.28 0.111 0.911
左心室舒张末期室间隔厚度(mm) 9.15±0.91 9.13±0.72 0.101 0.920
左心室舒张末期内径(mm) 40.25±3.61 41.08±3.57 1.004 0.318
左心室收缩末期内径(mm) 30.12±1.19 30.51±1.06 1.468 0.145
V1/V2(cm·s－1/cm·s－1) 0.92±0.23 0.87±0.21 0.968 0.335
V1/V3(cm·s－1/cm·s－1) 8.16±1.39 10.29±1.58 6.427 0.001
LVEF(%) 53.02±4.19 54.16±4.57 1.156 0.251
表2 撤机失败的影响因素分析
因　素 β SE Wald P值 OR 95%CI
下限 上限
浅快呼吸指数 1.258 0.609 4.267 0.005 3.518 1.671 7.409
肺部超声评分 1.305 0.642 4.132 0.005 3.688 1.751 7.766
V1/V3 1.295 0.601 4.643 0.005 3.651 1.734 7.689
图1 心脏超声参数预测AECOPD并发呼吸衰竭患者撤机失败的ROC曲线
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