Ultrasound assessment of diaphragm thickness, contractility, and strain in healthy pediatric patients.
Ultrasound assessment of diaphragm thickness, contractility, and strain in healthy pediatric patients.
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对健康儿科患者膈肌厚度、收缩力和应变的超声评估。
DOI：
10.1002/ppul.26768
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发表时间：
2024
影响因子：
3.1
通讯作者：
Nishisaki,Akira
中科院分区：
文献类型：
--
作者：
Glau,ChristieL;Lin,ElainaE;Conlon,ThomasW;Himebauch,AdamS;Keim,GarrettP;Nishisaki,Akira
背景：基于超声的横膈膜评估在儿科急症护理中越来越普遍，但儿童横膈膜的基线厚度和收缩性值仍然未知。方法对年龄<18岁的健康儿童择期手术进行前瞻性观察研究。在自主呼吸和机械通气期间，通过超声测量呼气末隔膜厚度（Tdi‐exp）、增厚分数（DTF）和偏移。事后测定膜片应变和峰值应变率。在预先指定的年龄组（<1岁，1至<3岁，3至<6岁，6至<12岁和12至<18岁）以及有无机械通气的情况下比较测量结果。结果共评估50例受试者（每个年龄组10例）。基线平均Tdi - exp为0.19±0.04 cm， DTF为0.19±0.09，偏移量为1.69±0.97 cm，应变为−10.3±4.9，峰值应变速率为−0.48±0.21 s−1。Tdi - exp或DTF在各年龄组间无显著差异（p < 0.05）。横膈膜偏移随年龄增加而增加（p< 0.0001）。膈肌张力在12-17岁年龄组中显著增加（- 14.3±6.4），p=。048，但峰值应变率无年龄相关差异（p= .08）。机械通气时DTF（0.12±0.04）显著降低（p< 0.05）。0001)，偏移1.08±0.31 cm (p<。0001)，应变−4.60±1.93 (p<。峰值应变率−0.20±0.10 s−1（p< 0.01）。0001)，而与基线值相比，Tdi - exp（0.18±0.03 cm）没有变化（p= 0.25）。结论儿童Tdi - exp、DTF和膈峰应变率在各年龄组间相似。横膈膜偏移和张力在不同年龄组有所不同。在机械通气期间膈肌收缩力的所有测量值均降低。
BackgroundUltrasound‐based diaphragmatic assessments are becoming more common in pediatric acute care, but baseline pediatric diaphragm thickness and contractility values remain unknown.MethodsWe conducted a prospective, observational study of healthy children aged <18 years undergoing elective surgery. Diaphragm thickness at end‐expiration (Tdi‐exp), thickening fraction (DTF) and excursion were measured by ultrasound during spontaneous breathing and during mechanical ventilation. Diaphragm strain and peak strain rate were ascertained post hoc. Measurements were compared across a priori specified age groups (<1 year, 1 to <3, 3 to <6, 6 to <12, and 12 to <18 years) and with versus without mechanical ventilation.ResultsFifty subjects were evaluated (n= 10 per age group). Baseline mean Tdi‐exp was 0.19 ± 0.04 cm, DTF 0.19 ± 0.09, excursion 1.69 ± 0.97 cm, strain −10.3 ± 4.9, peak strain rate −0.48 ± 0.21 s−1. No significant difference in Tdi‐exp or DTF was observed across age groups (p> .05). Diaphragm excursion increased with age (p< .0001). Diaphragm strain was significantly greater in the 12–17‐year age group (−14.3 ± 6.4),p= .048, but there were no age‐related differences in peak strain rate (p= .08). During mechanical ventilation, there were significant decreases in DTF 0.12 ± 0.04 (p< .0001), excursion 1.08 ± 0.31 cm (p< .0001), strain −4.60 ± 1.93 (p< .0001), and peak strain rate −0.20 ± 0.10 s−1(p< .0001) while there was no change in Tdi‐exp 0.18 ± 0.03 cm (p= .25) when compared to baseline values.ConclusionPediatric Tdi‐exp, DTF, and diaphragm peak strain rate were similar across age groups. Diaphragm excursion and strain varied across age groups. All measures of diaphragm contractility were diminished during mechanical ventilation.