摘要
Abstract
Objective To analyze the factors influencing the weaning failure in mechanically ventilated sepsis patients,and to explore the predictive value of combined ultrasonographic diaphragmatic excursion and thickening fraction for weaning outcomes of the patients.Methods Totally 107 sepsis patients undergoing mechanical ventilation at some hospital from January 2021 to June 2024 had their data collected retrospectively,who were divided into a weaning failure group(n=33)and a weaning success group(n=74)based on their weaning outcomes.The two groups were compared in terms of baseline characteristics,ultrasonographic diaphragmatic excursion,ultrasonographic diaphragmatic thickening fraction and other laboratory indicators,and the relationships were analyzed between the weaning failure of sepsis patients and ultrasonographic diaphragmatic excursion,ultrasonographic diaphragmatic thickening fraction and other key indicators.The factors identified in univariate analysis that might contribute to ventilator disconnection failure in sepsis patients(P<0.05)were included into multivariate Logistic regression analysis.ROC curves were plotted to evaluate the values of ultrasonographic diaphragmatic excursion,ultrasonographic diaphragmatic thickening fraction and their combination for predicting the weaning failure of the sepsis patients.R language rms package was used to incorporate the variables with P<0.05 from the multivariate analysis into a predictive model and to generate a nomogram,the C-index was calculated,and the ROC curve,calibration curve and decision curve were plotted to evaluate the model's predictive performance and clinical net benefit.Statistical analysis was performed using SPSS 25.0 software.Results The two groups had significant differences in infection site(P<0.05);when compared with the weaning success group,the weaning failure group had higher values of acute physiology and chronic health evaluationⅡ(APACHEⅡ)score,C reactive protein(CRP),procalcitonin(PCT)and rapid shallow breathing index(RSBI)while lower values of albumin(ALB),ultrasonographic diaphragmatic excursion and thickening fraction,with the differences being statistically significant(all P<0.05).The ROC curve indicated the ultrasonographic diaphragmatic excursion,thickening fraction and their combination all could be used for predicting the weaning failure,and the combination with an AUC value of 0.904 behaved better than either ultrasonographic diaphragmatic excursion or thickening fraction.The nomogram and the prediction model incorporating ALB,RSBI,ultrasonographic diaphragmatic excursion and thickening fraction showed C-index was 0.988,and the model gained excellent discriminative ability;ROC curve found AUC was 0.988 and the prediction model had high predictive performance;the calibration curve proved to approach the ideal curve;the decision curve revealed that the predictive model had a higher net benefit rate for predicting the weaning failure of sepsis patients when compared with the single indicators.Conclusion Combined ultrasonographic diaphragmatic excursion and thickening fraction has a high predictive value for the weaning failure of sepsis patients,and the nomogram based on ultraso-nographic diaphragmatic excursion and thickening fraction,ALB and RSBI can be used for the prediction of weaning outcomes of sepsis patients.[Chinese Medical Equipment Journal,2026,47(1):63-70].关键词
超声/膈肌活动度/膈肌增厚率/脓毒症/机械通气/撤机结局/撤机失败Key words
ultrasound/diaphragmatic excursion/diaphragmatic thickening fraction/sepsis/mechanical ventilation/wea-ning outcome/weaning failure分类
医药卫生
