中医证型及简化肺通气与膈肌运动超声评分指导脱机的临床研究

发布时间：2018-06-29 23:52

本文选题：脱机 + 超声　；参考：《南京中医药大学》2016年硕士论文

【摘要】：目的：探索超声评分评估机械通气脱机的有效性,同时研究中医证型对脱机的影响。方法：采用超声评估肺通气及膈肌运动情况,制定肺通气及膈肌运动评分表,评估机械通气病人评分。共纳入徐州市中心医院ICU自2015年03月至2016年02月的需要机械通气辅助呼吸的病人50名,并对其进行评分。按照脱机的结果将患者分为脱机成功组和脱机失败组,其中脱机成功组28例,脱机失败组22例。对所有患者进行简化肺通气与膈肌运动超声评分,使用统计学方法分析成功组与失败组的超声评分是否具有统计学意义,超声预测脱机的截止值是通过ROC曲线来测得的。同时对于所有纳入的患者机械通气前的中医证型进行记录,并且使用统计学的方法对中医证型与撤机之间的联系进行分析。结果：简化肺通气与膈肌运动超声评分在成功组及失败组两组间具有统计学差异(P0.05)。简化肺通气与膈肌运动超声评分的ROC曲线下面积是0.683,截止值是8分,敏感性是54.5%,特异性是75%。机械通气前成功组中医证型由高到低分别为痰浊壅肺证,痰瘀阻肺证、痰热阻肺证、痰蒙神窍证、肺脾肾虚证以及正虚喘脱证。机械通气前失败组中医证型由高到低分别为正虚喘脱证、肺脾肾虚证、痰蒙神窍证、痰热阻肺证、痰浊壅肺证以及痰瘀阻肺证。结论：简化肺通气与膈肌运动超声评分可以预测脱机的结果,并且具有良好的预测价值,当其评分在8分以下时,脱机成功可能性大。机械通气前中医证型为痰浊壅肺证时脱机成功率最高,为正虚喘脱证时脱机成功率最低。
[Abstract]:Objective: to evaluate the effectiveness of mechanical ventilation weaning by ultrasonic scoring, and to study the effect of TCM syndrome type on weaning. Methods: pulmonary ventilation and diaphragm motion were evaluated by ultrasound. A total of 50 patients in ICU of Xuzhou Central Hospital from March 2015 to February 2016 needed mechanical ventilation to assist breathing. According to the results of weaning, the patients were divided into two groups: successful group and failed group, including 28 cases of successful group and 22 cases of failed group. All patients were evaluated with simplified pulmonary ventilation and diaphragm motion. The ultrasonic score of successful group and failed group was statistically significant. The cut-off value of weaning was measured by ROC curve. At the same time, all the patients before mechanical ventilation were recorded, and the statistical method was used to analyze the relationship between TCM syndromes and weaning machines. Results: there were significant differences between the successful group and the failure group (P0.05). The area under ROC curve, cutoff value, sensitivity and specificity were 0.683, 8, 54.5 and 75g, respectively. Before mechanical ventilation, the TCM syndrome types of successful group from high to low were phlegm and turbid obstruction, phlegm stasis, phlegm heat blocking lung, phlegm and spirit orifices, deficiency of lung, spleen and kidney, and syndrome of asthenia due to asthenia. Before mechanical ventilation failure group TCM syndrome types from high to low were positive asthmatic syndrome, lung, spleen and kidney deficiency syndrome, phlegm and spirit orifices syndrome, phlegm heat blocking lung syndrome, phlegm stagnation lung syndrome and phlegm stagnation syndrome. Conclusion: simplified pulmonary ventilation and diaphragm motion ultrasound score can predict the results of weaning, and have good predictive value. When the score is below 8, the success of weaning is more likely. Before mechanical ventilation, the success rate of weaning was the highest in the syndrome of phlegm and turbid obstruction of the lung, and the lowest in the syndrome of dyspnea due to deficiency and asthma.
【学位授予单位】：南京中医药大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R259

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