【罂粟摘要】膈肌回声密度增加与腹部大手术患者术后肺部并发症相关：一项前瞻性观察研究

膈肌回声密度增加与腹部大手术患者术后肺部并发症相关：一项前瞻性观察研究

贵州医科大学  麻醉与心脏电生理课题组

翻译:黄祥

编辑：马艳燕

审校：曹莹

背景：术后肺部并发症（PPCs）与患者死亡率的增加相关，经常发生在腹部大手术之后。膈肌功能障碍被认为在PPCs的发展中起着重要作用，膈肌回声密度可作为膈肌功能的指标。本研究旨在确定膈肌回声密度是否可以预测腹部大手术后患者的PPCs发生情况。

方法：在自主呼吸试验期间收集了腹部大手术后患者的膈肌超声图像。基于灰度值的右偏分布对回声密度进行量化。结果包括PPCs的发生率、重新插管率、通气时间和ICU停留时间。

结果：连续测量了 117 名患者的膈肌回声密度。发生PPC的患者表现出更高的 ED50（35.00VS26.00，p<0.001）、更高的 ED85（64.00VS55.00，p<0.001）和更高的 EDmean（39.32VS33.98，p<0.001）。在ROC曲线分析中，预测PPCs的ED50曲线下面积为0.611。预测PPC发生的最佳ED50截断值为36。根据此最佳ED50截断值，将患者进一步分为高危组（ED50>36，n=35）和低危组（ED50≤36）, n=82)。与低危组相比，高危组的PPC发生率更高。

结论：在机械通气患者中，膈肌回声密度可以被重复地测量。自主呼吸试验期间膈肌回声密度的增加与腹部大手术后患者发生 PPC 的风险增加有关。

原始文献来源：Fu X,Wang Z,Wang L, et al. Increased diaphragm echodensity correlates with postoperative pulmonary complications in patients after major abdominal surgery: a prospective observational study. BMC Pulm Med. 2022;22 (1):400.

英文原文：

Increased diaphragm echodensity correlates with postoperative pulmonary complications in patients after major abdominal surgery: a prospective observational study

Background: Associated with increased morbidity and mortality, postoperative pulmonary complications (PPCs) often occur after major abdominal surgery. Diaphragmatic dysfunction is suggested to play an important role in the development of PPCs and diaphragm echodensity can be used as an indicator of diaphragm function. This study aimed to determine whether diaphragm echodensity could predict the occurrence of PPCs in patients after major abdominal surgery.

Methods: Diaphragm ultrasound images of patients after major abdominal surgery were collected during spontaneous breathing trials. Echodensity was quantified based on the right-skewed distribution of grayscale values (50th percentile, ED50; 85th percentile, ED85; mean, EDmean). Intra- and inter-analyzer measurement reproducibility was determined. Outcomes including occurrence of PPCs, reintubation rate, duration of ventilation, and length of ICU stay were recorded.

Results: Diaphragm echodensity was measured serially in 117 patients. Patients who developed PPCs exhibited a higher ED50 (35.00 vs. 26.00, p<0.001), higher ED85 (64.00 vs. 55.00, p<0.001) and higher EDmean (39.32 vs. 33.98, p<0.001). In ROC curve analysis, the area under the curve of ED50 for predicting PPCs was 0.611. The optimal ED50 cutoff value for predicting the occurrence of PPCs was 36. According to this optimal ED50 cutoff value, patients were further divided into a high-risk group (ED50>36, n=35) and low-risk group (ED50≤36, n=82). Compared with the low-risk group, the high-risk group had a higher incidence of PPCs (unadjusted p=0.003; multivariate-adjusted p<0.001).

Conclusion：Diaphragm echodensity can be feasibly and reproducibly measured in mechanically ventilated patients. The increase in diaphragm echodensity during spontaneous breathing trials was related to an increased risk of PPCs in patients after major abdominal surgery.

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