重症肺炎合并急性呼吸窘迫综合征患者机械通气撤机失败的影响因素及膈肌与肺功能超声的预测价值分析OA

Objective To evaluate the value of lung ultrasound score(LUS)combined with diaphragm function indicators in predicting the outcome of mechanical ventilation(MV)weaning in patients with acute respiratory distress syndrome(ARDS).Methods A retrospective analysis was conducted on 200 patients with severe pneumonia and ARDS in Jiujiang NO.1 Peo-ple's Hospital from January 2020 to October 2024.Baseline data of the patients,as well as diaphragm thickness change rate(TF),diaphragm muscle mobility(DM),LUS,MV time,Acute physiology and chronic health evaluation Ⅱ(APACHE Ⅱ),and sequential organ failure assessment(SOFA)were collected.The outcome of weaning was used as the dependent variable.Univariate and multivariate logistic regression analyses were performed to identify the independent influencing factors for weaning failure.The predictive value of LUS combined with diaphragm function for the outcome of MV weaning in patients with severe pneumonia and ARDS was evaluated using the ROC curve.Results The rate of MV weaning failure was 24.50％.Univariate analysis showed that the severity of the patient's condition,MV time,TF,DM,LUS,APACHE Ⅱ,and SOFA score were all independent influencing factors for the outcome of MV weaning in patients with severe pneumonia and ARDS(P＜0.05).Multivariate logistic analysis showed that the severity of the condition(β=1.214,OR=3.366,95％CI:1.677-6.755),MV time(β=0.474,OR=1.606,95％CI:1.213-2.125),TF(β=-0.112,OR=0.894,95％CI:0.810-0.987),DM(β=-2.200,OR=0.111,95％CI:0.032-0.382),LUS(β=0.692,OR=1.997,95％CI:1.532-2.603),APACHE Ⅱ score(β=0.240,OR=1.272,95％CI:1.019-1.586),and SOFA score(β=0.423,OR=1.526,95％CI:1.120-2.079)were all independent influencing factors for the outcome of MV weaning in patients with severe pneumonia and ARDS(P＜0.05).ROC analysis showed that the com-bined model of diaphragm function and lung function ultrasound indicators+confounding factors had the highest predictive value for the outcome of MV weaning in patients with severe pneumonia and ARDS:AUC was 0.939(95％CI:0.902-0.975).Conclusion Diaphragm function and lung function ultrasound indicators are key predictive factors for MV weaning failure in patients with severe pneumonia and ARDS,and the combined assessment of these three indicators has high predictive value.