目的应用床旁超声评估脓毒症患者膈肌的形态与功能改变。
方法2018年9月至2019年2月于中国医科大学附属盛京医院呼吸与危重症医学科进行横断面研究，以确诊脓毒症7 d内且序贯性器官功能衰竭（SOFA）评分≤5分的患者为脓毒症组（31例），同时期门诊健康体检人员为对照组（38例）。比较两组研究对象的临床资料，床旁超声测得膈肌形态指标（平静呼气末厚度、最大吸气末厚度）及功能指标（膈肌增厚率、平静呼吸移动度及深呼吸移动度）。计量资料比较用 t检验或Mann-Whitney U检验，计数资料比较用χ 2检验。
结果（1）脓毒症组和对照组性别、年龄、体重指数、基础疾病及平均动脉压差异均无统计学意义（均 P>0.05）；（2）膈肌形态指标：①两组平静呼气末膈肌厚度差异无统计学意义[脓毒症组为0.21（0.18~0.23）cm，对照组为0.19（0.16~0.20）cm， Z=-1.739， P=0.082]；②两组最大吸气末膈肌厚度差异无统计学意义[脓毒症组为（0.27±0.84）cm，对照组为（0.29±0.77）cm， t=1.344， P=0.183]；（3）膈肌功能指标：①脓毒症组膈肌增厚率明显小于对照组[脓毒症组为24%（16%~56%），对照组为61%（37%~82%）， Z=-3.076， P=0.002]；②脓毒症组平静呼吸膈肌移动度明显小于对照组[脓毒症组为（1.25±0.38）cm，对照组为（1.65±0.82）cm， t=2.687， P=0.009]；③脓毒症组深呼吸膈肌移动度明显小于对照组[脓毒症组为2.79（1.80~4.16）cm，对照组为3.77（2.92~5.05）cm， Z=-2.231， P=0.026]。
结论脓毒症（SOFA评分≤5分）患者7 d内已出现膈肌功能障碍，此时形态未见改变，提示脓毒症患者膈肌功能障碍早于萎缩发生。床旁超声可有效评估膈肌形态及功能。
ObjectiveTo evaluate the changes of the diaphragmatic morphology and function in septic patients by bedside ultrasound.
MethodsA cross-sectional study was conducted in the Department of Pulmonary and Critical Care Medicine, Shengjing Hospital of China Medical University over a 6-month period from September 2018 to February 2019. Thirty-one septic patients who were diagnosed within the past 7 days with Sequential Organ Failure Assessment (SOFA) scores less than or equal to 5 points were enrolled in the septic group. Thirty-eight healthy subjects who underwent regular physical examinations during the same period were enrolled randomly in the control group. All subjects′ clinical data, diaphragmatic morphology parameters (thickness at the end of quiet expiration, thickness at the end of deep inspiration) and function parameters (thickening fraction, quiet breath excursion and deep breath excursion) measured with bedside ultrasound were compared. The comparison of continuous variables was performed by using the Student t-test or Mann-Whitney U test. Chi-square test was performed for categorical variables. A value of P less than 0.05 was considered statistically significant.
Results(1) There was no statistical difference in gender, age, body mass index, underlying diseases and mean arterial pressure between the septic group and the control group (all P>0.05). (2) Diaphragmatic morphology parameters: There was no statistical difference between the septic group and the control group in the thickness at the end of quiet expiration [septic group: 0.21 (0.18-0.23) cm; control group: 0.19(0.16-0.20) cm, Z=-1.739, P=0.082] or in the thickness at the end of deep inspiration [septic group: (0.27±0.84) cm; control group: (0.29±0.77) cm, t=1.344, P=0.183]. (3) Diaphragmatic function parameters: The thickening fraction in the septic group was significantly less than that in the control group [septic group: 24% (16%-56%); control group:61% (37%-82%), Z=-3.076, P=0.002]. The quiet breath excursion in the septic group was significantly less than that in the control group [septic group: (1.25±0.38) cm; control group: (1.65±0.82) cm, t=2.687, P=0.009]. The deep breath excursion in the septic group was also significantly less than that in the control group [septic group: 2.79 (1.80-4.16)cm; control group:3.77(2.92-5.05)cm, Z=-2.231, P=0.026].
ConclusionIn septic (SOFA scores≤5 points) patients, diaphragmatic dysfunction occurred without significant morphology change in the first 7 days. Diaphragmatic dysfunction occurred before atrophy. Bedside ultrasound is a useful clinical tool in diaphragmatic morphology and function evaluation.
韩铭欣,潘萌萌,宋维,等. 床旁超声评估脓毒症患者膈肌的形态与功能研究[J]. 中华结核和呼吸杂志,2020,43(1)：35-39.
DOI:10.3760/cma.j.issn.1001-0939.2020.01.009版权归中华医学会所有。
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韩铭欣：实验设计、数据采集、统计分析、论文撰写；潘萌萌：数据采集、统计分析；宋维：数据采集、统计分析；廖明喻：实验指导、论文修改；武免免：实验指导、论文修改；陈云秋：数据整理、统计分析；柳文娟：数据整理、统计分析；焦光宇：实验设计、数据分析、论文撰写与修改
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