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目的:评价膈肌电位(Edi)及神经肌肉强度指数(NMS)对撤机的指导意义。方法:以入住东南大学附属中大医院ICU行机械通气超过24 h且准备撤机的患者为对象,行自主呼吸实验(SBT)30 min,监测期间Edi、NMS、浅快呼吸指数(呼吸频率/潮气量,f/Vt)、口腔闭合压(P_(0.1))及吸气时间比值(Ti/tot)等撤机指标。结果:44例患者中16例撤机失败。(1)SBT 30 min时,撤机失败患者的Edi明显高于撤机成功患者(P<0.05)。(2)SBT 0、5及30 min时撤机失败患者的NMS均显著高于撤机成功患者(P<0.05)。(3)SBT30 min时,Edi和NMS的ROC曲线下面积(AUC)分别为0.785和0.778(P<0.05);以Edi>17μV为预测撤机临界值时,敏感性为81.8%,特异性为72.0%;以NMS>339μV·bpm为预测撤机的临界值时,敏感性为100%,特异性为56.0%。结论:SBT 30 min时Edi和NMS对撤机失败具有较高的预测价值,是良好的临床撤机指标。
Objective: To evaluate the guiding significance of diaphragmatic potential (Edi) and neuromuscular intensity index (NMS) on weaning. Methods: The spontaneous breathing test (SBT) was performed for 30 minutes in patients admitted to the ICU of CUHK University Hospital of Southeast University with mechanical ventilation more than 24 hours and ready to be weaned. Edi, NMS, superficial respiratory index (respiratory rate / Tidal volume, f / Vt), oral closure pressure (P_ (0.1)) and inspiratory time ratio (Ti / tot) and other weaning indicators. Results: Of the 44 patients, 16 had weaning failure. (1) At 30 min SBT, the Edi of patients with weaning failure was significantly higher than that of patients with weaning success (P <0.05). (2) The patients with weaning failure at 0, 5 and 30 min after SBT were significantly higher than those with weaning success (P <0.05). (3) The area under the ROC curve (EUC) of Edi and NMS were 0.785 and 0.778 (P <0.05) at SBT of 30 min and 81.8% with Edi> 17 μV and the specificity was 72.0%; when NMS> 339μV · bpm was the predictive value of weaning threshold, the sensitivity was 100% and the specificity was 56.0%. Conclusion: Edi and NMS at 30 min SBT have a high predictive value for weaning failure, which is a good indicator of clinical weaning.