Increased diaphragm echodensity correlates with postoperative pulmonary complications in patients after major abdominal surgery: a prospective observational study.
Increased diaphragm echodensity correlates with postoperative pulmonary complications in patients after major abdominal surgery: a prospective observational study.
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腹部大手术后膈肌回声密度增加与术后肺部并发症相关：一项前瞻性观察研究
DOI：
10.1186/s12890-022-02194-6
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发表时间：
2022-11-04
影响因子：
3.1
通讯作者：
中科院分区：
文献类型：
--
作者：
伴随着发病率和死亡率的增加，腹部大手术后常常会发生术后肺部并发症(PPC)。横隔膜功能障碍在PPC的发生发展中起重要作用，横隔膜回声密度可作为反映横隔膜功能的指标。本研究旨在确定横隔膜回声密度是否能预测腹部大手术后PPC的发生。在自主呼吸试验期间，收集了腹部大手术后患者的横隔膜超声图像。回声密度的量化基于灰阶值的右偏分布(第50百分位数，ED50；第85百分位数，ED85；平均值，EDean)。测定分析仪内和分析仪间测量的重复性。记录结果，包括PPC的发生、再插管率、呼吸机持续时间和ICU住院时间。连续测量117例患者的横隔膜回声密度。发展为PPC的患者表现出更高的ED50值(35.00vs.26.00p <； 0.001)、高ED85值(64.00vs.55.00p <； 0.001)和更高的ED均值(39.32vs.33.98p <； 0.001)。在ROC曲线分析中，预测PPC的ED50曲线下面积为0.611。预测PPC发生的最佳ED50临界值为36。根据此最佳ED50临界值，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PPC的发生率更高(未调整p = 0.003；多因素调整p <； 0.001)。在机械通气患者中，可以可行且可重复性地测量横隔膜回声密度。自主呼吸试验中横隔膜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。网上版载有补充材料，可在10.1186/s12890-022-02194-6查阅。
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. 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. 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). 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. The online version contains supplementary material available at 10.1186/s12890-022-02194-6.
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DOI：
10.7863/ultra.15.04065
发表时间：
2016-09
期刊：
Journal of ultrasound in medicine : official journal of the American Institute of Ultrasound in Medicine
影响因子：
--
作者：
Koppaka S;Shklyar I;Rutkove SB;Darras BT;Anthony BW;Zaidman CM;Wu JS
通讯作者：
Wu JS
影响因子：
3.4
作者：
Zaidman, Craig M.;Holland, Mark R.;Pestronk, Alan
通讯作者：
Pestronk, Alan
影响因子：
8.8
作者：
Puthucheary, Zudin A.;Phadke, Rahul;Montgomery, Hugh E.
通讯作者：
Montgomery, Hugh E.
DOI：
10.1164/rccm.201703-0536oc
发表时间：
2018-01-15
影响因子：
24.7
作者：
Goligher, Ewan C.;Dres, Martin;Ferguson, Niall D.
通讯作者：
Ferguson, Niall D.
影响因子：
8.8
作者：
Canet, Jaume;Gallart, Lluis;Sanchis, Joaquin
通讯作者：
Sanchis, Joaquin