Reproducibility and Clinical Correlates of Supine Diaphragmatic Motion Measured by M-Mode Ultrasonography in Healthy Volunteers
Reproducibility and Clinical Correlates of Supine Diaphragmatic Motion Measured by M-Mode Ultrasonography in Healthy Volunteers
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DOI：
10.1159/000489229
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发表时间：
2018-01-01
期刊：
影响因子：
3.7
通讯作者：
Incalzi, Raffaele Antonelli
中科院分区：
文献类型：
--
作者：
Scarlata, Simone;Mancini, Damiana;Incalzi, Raffaele Antonelli
工作背景：评估膈肌活动度对于检测功能障碍或即将发生的衰竭以及评估许多胸部和腹部疾病对呼吸力学的影响非常重要。在几种成像方法中，超声检查是唯一一种广泛用于直接评估横膈膜偏移的无创、非电离成像技术。目的：本研究的目的是前瞻性地评估健康志愿者样本中通过M型超声检查测量的仰卧横膈膜运动幅度、观察者内和观察者间的一致性以及横膈膜运动变异性的人体测量相关性。方法：100名健康志愿者被认为有资格参加这项研究。代替B模式成像，使用M模式技术来实现更精确的隔膜运动测量。为了评估观察者内变异性，在每次会话中获得右侧圆顶运动的3个连续测量值（M模式和B模式）。为了测试评估者间的可靠性，要求受试者每周再提供2次横膈膜运动测量结果，每次由2名经验丰富的操作员进行，42名受试者接受。结果如下：安静时膈肌运动与身高、体重均呈正相关（斯皮尔曼系数= 0.514，p < 0.001和0.314，p = 0.038）和深呼吸（斯皮尔曼系数分别为0.342，p = 0.001和0.225，p = 0.024），与年龄呈负相关，但仅在深呼吸期间（斯皮尔曼系数=-0.272，p = 0.006）。在安静和深呼吸期间，所有3个测量值的观察者内一致性程度都非常好，Cronbach α分别为0.793和0.901，组内系数分别为0.797和0.900。同样，观察者之间的一致性程度分别达到了0.638和0.776的Cronbach α，以及0.632和0.778的类间系数。在线性多变量模型中，深呼吸仅与性别相关（B = -10.14; 95%置信区间[CI]-17.86，-2.41; p= 0.011），而安静呼吸仅受身高影响（B = 30.05; 95% CI 0.79-59.31; p = 0.044）。结论：使用M模式技术的横膈膜偏移测量是准确的，也可以重现时，在横卧的患者。调整后，主要的预测因素，椎弓根运动的性别和身高，应考虑设计一个专门定制的研究，并制定正常参考方程。(C)2018年S. Karger AG，巴塞尔
Background: Assessing diaphragm mobility is important to detect malfunctions or impending exhaustion and to evaluate the effects of many chest and abdominal conditions on respiratory mechanics. Amongst several imaging methods, ultrasonography represents the only noninvasive, nonionizing imaging technique widely available for the direct assessment of diaphragm excursion. Objectives: the aim of this study is to prospectively assess the supine diaphragmatic motion amplitude, intra- and inter-observer agreement, and anthropometric correlates of diaphragm motion variability, measured through M-mode ultrasonography, in a sample of healthy volunteers. Methods: Onehundred healthy volunteers were considered eligible for the study. Instead of B-mode imaging, the M-mode technique was used to achieve a more accurate measurement of diaphragm motion. To assess intra-observer variability, 3 consecutive measurements (M-mode and B-mode) of the right dome motion were obtained at every session. To test for inter-rater reliability, the subjects were asked to provide 2 more diaphragm motion measurements every week, each performed by 2 experienced operators, and 42 subjects accepted. Results: Diaphragmatic motion was positively correlated with height and weight both at quiet (Spearman's coefficient = 0.514, p < 0.001 and 0.314, p = 0.038) and deep breathing (Spearman's coefficient = 0.342, p = 0.001 and 0.225, p = 0.024, respectively) and negatively correlated with age, but only during deep breathing (Spearman's coefficient = -0.272, p = 0.006). Intra-observer agreement degree on all 3 measurements was excellent during both quiet and deep breathing, with a Cronbach's alpha of 0.793 and 0.901, respectively, and an intra-class coefficient of 0.797 and 0.900, respectively. Similarly, the degree of inter-observer agreement achieved a Cronbach's alpha of 0.638 and 0.776, and an inter-class coefficient of 0.632 and 0.778, respectively. Deep breathing was associated with sex only in linear multivariable models (B = -10.14; 95% confidence interval [CI] -17.86, -2.41; p= 0.011), while quiet breathing resulted to be affected by height only (B = 30.05; 95% CI 0.79-59.31; p = 0.044). Conclusions: Diaphragm excursion measurements using the M-mode technique were accurate and could be reproduced also when obtained in recumbent patients. After adjustments, the main predictors of diaphragmatic motion were sex and height, which should be considered to design a specifically tailored study and to develop normality reference equations. (C) 2018 S. Karger AG, Basel