Study on the prediction of echocardiography combined with diaphragmatic ultrasound on the outcome of removing machine for patients with cardiac valve replacement for mechanical ventilation

Yilan Yao; Cheng Zhou; Shenglin Ling; Jiangtao Han; Junlong YU; Hongqin BI

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Study on the prediction of echocardiography combined with diaphragmatic ultrasound on the outcome of removing machine for patients with cardiac valve replacement for mechanical ventilation

VernacularTitle:超声心动图联合膈肌超声对心脏瓣膜置换术机械通气患者撤机结局的预测研究
Author: Yilan YAO ¹ ; Cheng ZHOU ; Shenglin LING ; Jiangtao HAN ; Junlong YU ; Hongqin BI
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1. 宜宾市第一人民医院超声科宜宾 644000
Keywords: Echocardiography; Diaphragm ultrasound; Cardiac valve replacement; Mechanical ventilation; Outcome of removing machine; Predictive analysis
From: China Medical Equipment 2024;21(8):70-74,90
CountryChina
Language:Chinese
Abstract: Objective:To analyze the predictive value of echocardiography combined with diaphragmatic ultrasound on the outcome of removing machine for patients who underwent cardiac valve replacement for mechanical ventilation.Methods:Retrospectively,a total of 57 patients who adopt mechanical ventilation after underwent cardiac valve replacement in the First People's Hospital of Yibin from January 2022 to March 2023 were selected as the study subjects.According to the results of removing machine,the patients were divided into failed group(11 cases)and successful group(46 cases).All patients underwent echocardiography combined with diaphragmatic ultrasound examination.The indicators of echocardiography,included left ventricular ejection fractions(LVEF),right ventricular fractional area change(RVFAC)and systolic myocardial velocity(Sa),between different groups were compared.The early diastolic mitral annular tissue velocity(e')was recorded to calculate the ratio of early diastolic transmitral flow velocity(E)to e'(E/e'),and the indicators of echocardiography and diaphragmatic ultrasound.Logistic regression analysis was performed to analyze the factors affecting the failure of removing machine.Receiver operating characteristic(ROC)curve was drawn to evaluate the predictive values of echocardiography and diaphragmatic ultrasound indicators for the failure of removing machine in mechanical ventilation.Results:The differences of the differences of LVEF,RVFAC and Sa between failed group and successful group were no significant(P>0.05).The E/e'value of the successful group was 10.06±1.30,which was significantly lower than 12.69±2.96 of the failed group,and the difference was statistically significant(t=2.084,P＜0.05).The diaphragm thickening fraction(DTF)and diaphragm excursion(DE)values of the successful group were respectively 41.34±10.74 and 13.04±1.18,which were significantly higher than 19.67±5.37 and 11.27±0.94 of the failed group,respectively,and the differences between the two groups were statistically significant(t=2.148,2.776,P＜0.05).The results of logistic regression analysis showed that low expression of DTF and DE,as well as high expression of E/e',were all influence factors for the failure of removing machine for patients adopted mechanical ventilation after underwent cardiac valve replacement.The ROC results showed that the best cut-off value of the prediction model was 0.0893,and the area under curve(AUC)values were 0.713(95%CI:0.646～0.758),0.710(95%CI:0.651～0.779),0.752(95%CI:0.657～0.805)and 0.886(95%CI:0.782～0.991).Conclusion:The combination of echocardiography and diaphragm ultrasound has better prediction for the outcome of removing machine,which high higher clinical application value.