Ultrasonographic Hemidiaphragmatic Weakness in Acute Respiratory Failure: Impact on Extubation Outcome

在急性呼吸衰竭之病患，以超音波評估單側橫膈膜肌無力之情形：分析其對拔管預後之影響

江榮人(Jung-Rern Jiang) ； 鄭之勛(Jih-Shuin Jerng) ； 楊泮池(Pan-Chyr Yang)

《胸腔醫學》 18卷5期 (2003/10) Pp. 392-401

https://doi.org/10.29806/TM.200310.0002

摘要

背景：單側橫膈膜肌無力對於呼吸衰竭病人拔管失敗率的影響目前仍不明。
方法：本研究以超音波對內科加護病房內急性呼吸衰竭之病患評估其橫膈膜肌收縮之情形，病患均接受氣管內插管及呼吸器輔助呼吸。以肝臟及脾臟的移動代表橫膈膜的移動，我們測量其於病患自主性呼吸時移動的情形，並測量傳統的呼吸器脫離指標，並將病患之臨床資料、影像學表現、傳統呼吸器脫離指標及超音波測量結果納入研究分析。
結果：在六個月期間，共有58位病患被完整地收案，其中，14位病患（24%）為單側橫膈膜肌無力；3位病患（5%）為雙側橫膈膜肌無力。肝臟和脾臟之移動平均值和吸氣最大壓力值（PImax）及自主性呼吸潮氣量（VTspon）的相關性不佳。在所有的單側橫膈膜肌無力病患中，僅67%病患在影像上顯示單側橫膈升高，而只有17%的病患的理學檢查發現有腹部矛盾性呼吸的情形。所有的病患中，拔除氣管內插管脫離呼吸器的失敗率為41%。本研究發現，雙側橫膈膜肌無力與拔管失敗率有相關，但單側橫膈膜肌無力和拔管失敗率並沒有統計學上的相關性。
結論：在我們的研究結果中，單側橫膈膜肌無力對急性呼吸衰竭病患之拔管失敗率無決定性的影響。以超音波測量肝臟及脾臟於自然呼吸下的移動來評估橫膈肌收縮是實用可行的方法。

關鍵字

肝臟及脾臟移動 ； 單側橫膈膜肌無力 ； 拔管預後 ； 超音波

並列摘要

Background: The impact of hemidiaphragmatic weakness on the extubation outcome is unclear.
Methods: We performed ultrasonographic evaluations of the hemidiaphragms of patients with acute respiratory failure treated in the medical ICU. The patients were intubated and mechanically ventilated. At the beginning of a spontaneous breathing trial before extubation, the movements of the liver and spleen, which represented the hemidiaphragmatic movements, as well as conventional weaning parameters, were measured. Clinical data, radiographic findings, weaning parameters, and ultrasonographic findings were analyzed.
Results: During a study period of six months, 58 patients completed ultrasonographic study. Among them, 14 (24%) patients had unilateral hemidiaphragmatic weakness and 3 (5%) had bilateral weakness. The mean values of liver and spleen displacement did not correlate well with PImax and VTspon (R square = 0.19 and 0.16, respectively). In patients with unilateral hemidiaphragmatic weakness, 67% showed radiographic evidence of hemidiaphragmatic elevation, and only 17% showed abdominal paradoxical movements. The extubation failure rate for all patients was 41%. We found that bilateral hemidiaphragmatic weakness, but not unilateral hemidiaphragmatic weakness, is associated with a poor extubation outcome.
Conclusion: Unilateral hemidiaphragmatic weakness does not have significant impact on the extubation outcome of patients with acute respiratory failure. Ultrasonographic measurements of liver and spleen displacement during spontaneous breathing is a feasible method for evaluating hemidiaphragmatic movement.

並列關鍵字

Liver and spleen movements ； Hemidiaphragmatic weakness ； Extubation outcome ； Ultrasonography