【摘要】 目的 应用超声测定膈肌功能指导无创机械通气在急性心力衰竭患者中的应用。方法 36例具有高碳酸血症的急性心力衰竭患者，按照无创机械通气效果分为有效组和无效组。并以超声测定的膈肌厚度变化率（ΔTd）≤20%定义为膈肌功能障碍。比较有效组和无效组之间的基本参数和膈肌超声指标。分析膈肌功能正常组和障碍组之间的主要临床结果。应用ROC曲线了解ΔTd预测无创机械通气无效的价值。结果 共有17例患者通过早期超声发现存在膈肌功能障碍。其中有效组1例，无效组16例。有效组膈肌障碍发生数和膈肌厚度变化率均显著低于无效组，而吸气末膈肌厚度显著高于无效组（P<0.05）。膈肌功能障碍组NIV治疗失败率、住院时间和3月内再住院人数均显著高于膈肌功能正常组（P<0.05）。ROC曲线显示，以ΔTd曲线下面积显著高于PH、ΔPH、ΔPaCO₂曲线下面积。结论 超声测定膈肌功能可以作为指导急性心力衰竭患者NIV通气治疗的指标之一。更多还原

【Abstract】 Objective The application of noninvasive mechanical ventilation (NIV) guided by diaphragmatic function in acute heart failure (AHF) was studied by ultrasound.Methods Thirty-six patients with AHF with hypercapnic acidosis were enrolled.The subjects were stratified into the effective group and the ineffective group based on the results of NIV.Change in diaphragm thickness (ΔTdi) <20% was defined as the diaphragmatic dysfunction.The baseline clinical characteristics and index of ultrasound between NIV effective group and the ineffective group were investigated.The main clinical results between normal diaphragm function group and disorder group were analyzed.The correlation among NIV failure and ΔTd as compared with the others indexes was assessed through ROC analysis.Results A total of 17 patients were found to have diaphragm dysfunction by early ultrasound.There were 1 case in the effective group and 16 cases in the ineffective group.The number of diaphragm disorders and the change rate of diaphragm thickness in the effective group were significantly lower than those in the ineffective group,while the diaphragm thickness at the end of inspiration was significantly higher than that in the ineffective group (P<0.05).The failure rate of NIV treatment,the length of hospital stay and the number of rehospitalization within 3 months in the diaphragm dysfunction group were significantly higher than those in the normal diaphragm function group (P<0.05).ROC curve display,in the ΔTd area under curve is significantly higher than pH,ΔpH,ΔPaCO2 area under curve.Conclusion Ultrasonic measurement of diaphragm function can be used as one of the indexes to guide NIV ventilation treatment in patients with acute heart failure.更多还原