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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) ›› 2026, Vol. 19 ›› Issue (03) : 392 -398. doi: 10.3877/cma.j.issn.1674-6902.2026.03.006

论著

肺超声联合膈肌超声检测指标预测急性呼吸窘迫综合征患者拔管的临床研究—附126例分析
张阿妮1, 王冠华1, 袁亚迎2, 任志超3, 梁杰3, 赵蕊新1, 陈妍1, 郭娟妮1, 康瑞1,†()   
  1. 1712000　咸阳，咸阳市第一人民医院超声医学科
    2712000　咸阳，咸阳市第一人民医重症医学科
    3712000　咸阳，咸阳市第一人民医院呼吸与危重症医学科
  • 收稿日期:2025-12-21 出版日期:2026-06-25
  • 通信作者: 康瑞
  • 基金资助:
    咸阳市科学技术社会发展计划项目(2021ZDYF-SF-0058)

Clinical significance of lung ultrasound and diaphragmatic ultrasound in predicting extubation risk in 126 patients with acute respiratory distress syndrome—analysis of 126 cases

Ani Zhang1, Guanhua Wang1, Yaying Yuan2, Zhichao Ren3, Jie Liang3, Ruixin Zhao1, Yan Chen1, Juanni Guo1, Rui Kang1,†()   

  1. 1Department of Ultrasound Medicine, Xianyang First People′s Hospital, Xianyang 712000, China
    2Department of Critical Care Medicine, Xianyang First People′s Hospital, Xianyang 712000, China
    3Department of Respiratory and Critical Care Medicine, Xianyang First People′s Hospital, Xianyang 712000, China
  • Received:2025-12-21 Published:2026-06-25
  • Corresponding author: Rui Kang
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引用本文：

张阿妮, 王冠华, 袁亚迎, 任志超, 梁杰, 赵蕊新, 陈妍, 郭娟妮, 康瑞. 肺超声联合膈肌超声检测指标预测急性呼吸窘迫综合征患者拔管的临床研究—附126例分析[J/OL]. 中华肺部疾病杂志(电子版), 2026, 19(03): 392-398.

Ani Zhang, Guanhua Wang, Yaying Yuan, Zhichao Ren, Jie Liang, Ruixin Zhao, Yan Chen, Juanni Guo, Rui Kang. Clinical significance of lung ultrasound and diaphragmatic ultrasound in predicting extubation risk in 126 patients with acute respiratory distress syndrome—analysis of 126 cases[J/OL]. Chinese Journal of Lung Diseases(Electronic Edition), 2026, 19(03): 392-398.

目的

探讨肺超声联合膈肌超声对急性呼吸窘迫综合征(acute respiratory distress syndrome, ARDS)患者拔管失败的预测价值。

方法

纳入2022年1月至2025年10月我院收治的126例ARDS患者，将拔管成功99例分为对照组，拔管失败27例分为观察组。患者自主呼吸试验结束后4 h行床旁超声检查，采用12分区法计算肺部超声(lung ultrasonography, LUS)评分，测量膈肌移位及膈肌增厚分数。比较两组临床资料及超声指标，采用LASSO回归及多因素Logistic回归分析拔管失败的危险因素，绘制受试者工作特征曲线(receiver operating characteristic, ROC)判断指标预测价值。

结果

观察组与对照组中位LUS评分(15.00分比9.00分，P<0.001)；观察组静息呼吸膈肌移位(quiet breathing diaphragmatic excursion, Q-DE)(P＝0.027)、深呼吸膈肌移位(deep breathing diaphragmatic excursion, D-DE)(P＝0.006)、静息呼吸膈肌增厚分数(quiet breathing diaphragmatic thickening fraction, Q-DTF)(P<0.001)、深呼吸膈肌增厚分数(deep breathing diaphragmatic thickening fraction, D-DTF)(P<0.001)低经多变量Logistic回归分析显示，序贯器官衰竭评分(sequential organ failure assessment, SOFA)(OR＝1.713)、氧合指数(OR＝0.991)、机械通气时长(OR＝1.078)、LUS评分(OR＝1.686)、D-DTF(OR＝0.872)是ARDS患者拔管失败的危险因素(P<0.05)。LUS评分联合D-DTF预测ARDS拔管结局的AUC达0.923(95%CI：0.861~0.963)，优于LUS评分[0.817(95%CI：0.732~0.876)，P＝0.003]或D-DTF[0.812(95%CI：0.732~0.876)，P＝0.009]单一指标预测。SOFA评分、氧合指数、机械通气时长、LUS评分、D-DTF共5个因素联合预测ROC曲线分析显示，临床＋床旁超声联合预测ARDS拔管失败AUC达0.969(95%CI：0.921~0.991)，敏感度和特异度分别达88.89%和93.94%。Hosmer-Lemeshow拟合优度检验显示拟合良好(χ2＝2.448，P＝0.964)。临床决策曲线分析显示，高风险阈值为0.03~0.95时，联合预测拔管失败净临床收益高。

结论

床旁多脏器超声监测可作为ARDS患者气管插管拔管重要评判手段。通过肺超声联合膈肌超声的床旁评估，结合ARDS患者临床症状与体征进行判断，可有效指导拔管时机的选择，有助于提高拔管成功率，对保障ARDS患者顺利、安全完成拔管具有临床意义。

关键词: 急性呼吸窘迫综合征, 肺超声评分, 膈肌超声, 临床研究
Objective

To investigate the predictive value of lung ultrasound combined with diaphragmatic ultrasound for extubation failure in patients with acute respiratory distress syndrome (ARDS).

Methods

A total of 126 ARDS patients admitted to our hospital from January 2022 to October 2025 were enrolled. Among them, 99 patients with successful extubation were assigned to the control group, and 27 patients with extubation failure were assigned to the observation group. Bedside ultrasonography was performed 4 hours after the completion of a spontaneous breathing trial. The lung ultrasound (LUS) score was calculated using the 12zone method, and diaphragmatic excursion and diaphragmatic thickening fraction were measured. Clinical data and ultrasound parameters were compared between the two groups. LASSO regression and multivariate logistic regression were used to analyze risk factors for extubation failure, and receiver operating characteristic (ROC) curves were plotted to evaluate the predictive value of each indicator.

Results

Compared with the control group, the observation group had a higher median LUS score (15.00 vs. 9.00, P<0.001), and lower values of quiet breathing diaphragmatic excursion (QDE) (P=0.027), deep breathing diaphragmatic excursion (DDE) (P=0.006), quiet breathing diaphragmatic thickening fraction (QDTF) (P<0.001), and deep breathing diaphragmatic thickening fraction (DDTF) (P<0.001). Multivariate logistic regression analysis showed that sequential organ failure assessment (SOFA) score (OR=1.713), oxygenation index (OR=0.991), duration of mechanical ventilation (OR=1.078), LUS score (OR=1.686), and DDTF (OR=0.872) were independent risk factors for extubation failure in ARDS patients (all P<0.05). The area under the curve (AUC) of the combination of LUS score and DDTF for predicting extubation outcome was 0.923 (95%CI: 0.861~0.963), which was superior to that of LUS score alone [0.817 (95%CI: 0.732~0.876), P=0.003] or DDTF alone [0.812 (95%CI: 0.732~0.876), P=0.009]. ROC curve analysis of the combined model including SOFA score, oxygenation index, duration of mechanical ventilation, LUS score, and DDTF showed that the combined clinical and bedside ultrasound model achieved an AUC of 0.969 (95%CI: 0.921~0.991), with a sensitivity of 88.89% and a specificity of 93.94%. The HosmerLemeshow goodnessoffit test indicated good calibration (χ2=2.448, P=0.964). Clinical decision curve analysis showed that when the highrisk threshold ranged from 0.03 to 0.95, the combined prediction of extubation failure provided a high net clinical benefit.

Conclusion

Bedside multi-organ ultrasound monitoring can serve as an important assessment tool for extubation in patients with ARDS. By combining bedside lung ultrasound with diaphragmatic ultrasound, together with the patient′s clinical symptoms and signs, this approach can effectively guide the selection of extubation timing, help improve the extubation success rate, and is of clinical significance in ensuring that ARDS patients are extubated smoothly and safely.

Key words: Acute respiratory distress syndrome, Lung ultrasound score, Diaphragmatic ultrasound, Clinical research
图1 ARDS患者床旁超声量化LUS评分图像。图A为右肺R1区两条孤立B线，正常通气；图B为右肺多条B线，肺通气中度丧失；图C为左肺广泛的融合B线，肺通气重度丧失，左肺局部实变，肺泡充气消失；图D为右肺组织实变
图2 ARDS患者床旁超声膈肌超声图像。图A为在锁骨中线右肋缘下方放置2~5 MHz凸阵探头，使用B型超声模式下识别运动幅度最大膈肌；图B为测量膈肌移位；图C为在腋中线附近第8和第10肋间位置放置3.5~10 MHz线阵探头，显示膈肌形态；图D为M型超声模式测量呼吸周期中膈肌厚度
表1 两组ARDS患者临床资料结果
临床资料 观察组(n＝27) 对照组(n＝99) t/χ2/Z值 P值
ARDS病因[n(%)]     2.070 0.150
肺源性 19(70.37) 82(82.83)    
肺外源性 8(29.63) 17(17.17)    
实验室指标[M(Q25，Q75)]        
白细胞计数(×109/L) 9.85(5.89，10.98) 11.60(6.88，13.85) －0.151 0.880
血小板计数(×109/L) 244.00(203.00，304.00) 272.00(215.50，324.00) －1.261 0.207
肌酸激酶同工酶MB(U/L) 25.00(19.80，48.50) 27.00(19.95，37.00) －0.318 0.750
乳酸脱氢酶(U/L) 465.00(320.75，584.75) 445.00(326.25，537.75) －1.035 0.301
降钙素原(ng/ml) 0.21(0.14，0.45) 0.13(0.05，0.34) －1.945 0.052
C反应蛋白(mg/L) 15.20(11.55，17.09) 10.58(4.70，17.58) －2.224 0.026
SOFA评分(分) 5.00(5.00，7.00) 4.00(3.00，5.00) －4.317 0.000
血气分析[M(Q25，Q75)]        
PaO2(mmHg) 85.50(64.50，106.25) 92.50(79.00，199.00) －1.379 0.168
PaCO2(mmHg) 56.50(51.25，66.75) 28.50(28.00，61.00) －1.456 0.145
氧合指数(mmHg) 154.00(96.40，203.00) 257.00(228.00，289.00) －4.254 0.000
通气指标(±s)        
PEEP(cmH2O) 13.33±1.44 12.21±1.98 3.287 0.002
气道峰压(cmH2O) 30.33±4.96 28.92±4.72 1.326 0.192
最大吸气压(cmH2O) 16.07±3.58 15.27±3.31 1.053 0.299
抗生素[n(%)] 27(100.00) 98(98.99) － 0.999
升压药[n(%)] 19(70.37) 38(38.38) 8.762 0.003
秋水仙碱[n(%)] 12(44.44) 28(28.28) 2.557 0.110
肾替代治疗[n(%)] 7(25.93) 8(8.08) 6.442 0.011
机械通气[d，M(Q25，Q75)] 21.00(13.00，27.00) 10.00(5.00，13.00) －3.992 0.000
表2 两组ARDS患者肺和膈肌超声检查比较
临床指标 观察组(n＝27) 对照组(n＝99) t/χ2/Z值 P值
LUS评分[分，M(Q25，Q75)] 15.00(13.00，19.00) 9.00(8.00，12.00) －5.069 0.000
膈肌超声        
Q-DTe[cm，M(Q25，Q75)] 0.23(0.2，0.25) 0.23(0.21，0.26) －0.191 0.849
Q-DTi[cm，(±s)] 0.29±0.04 0.31±0.05 1.916 0.058
D-DTe[cm，(±s)] 0.25±0.04 0.24±0.04 1.345 0.186
D-DTi[cm，(±s)] 0.36±0.05 0.38±0.08 1.420 0.160
Q-DE[cm，M(Q25，Q75)] 1.67(1.55，2.09) 2.03(1.67，2.24) －2.213 0.027
D-DE[cm，M(Q25，Q75)] 3.69(3.38，4.61) 4.71(3.79，5.24) －2.759 0.006
Q-DTF[%，M(Q25，Q75)] 25.00(22.73，29.74) 30.95(24.07，41.73) －3.932 0.000
D-DTF[%，M(Q25，Q75)] 37.04(30.91，44.00) 64.00(45.00，75.00) －4.939 0.000
表3 多变量Logistic回归分析拔管失败的危险因素
自变量 b SE(b) Walds值 OR(95%CI) P值
C反应蛋白 0.036 0.064 0.306 1.036(0.914~1.175) 0.580
SOFA评分 0.538 0.237 5.152 1.713(1.076~2.727) 0.023
氧合指数 －0.009 0.005 4.082 0.991(0.982~1.000) 0.043
机械通气时长 0.075 0.033 5.261 1.078(1.011~1.149) 0.022
LUS评分 0.522 0.139 14.202 1.686(1.285~2.213) 0.001
Q-DE －1.052 0.942 1.247 0.349(0.055~2.212) 0.264
D-DTF －0.137 0.055 6.158 0.872(0.782~0.972) 0.013
表4 床旁多脏器超声指标对ARDS患者拔管失败的预测效能
特　征 AUC 95%CI 敏感度(%) 特异度(%) 截断值 约登指数
SOFA评分 0.760 0.676~0.832 81.48 64.65 4分 0.461
氧合指数 0.768 0.684~0.838 81.48 67.68 218 mmHg 0.492
机械通气时长 0.751 0.666~0.824 77.78 68.69 12天 0.465
LUS评分 0.817 0.732~0.876 81.48 73.74 12分 0.552
D-DTF 0.812 0.732~0.876 88.89 57.58 45.22% 0.465
LUS评分联合D-DTF 0.923 0.861~0.963 81.48 86.87 0.28 0.684
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