低膈肌厚度可预测COVID-19肺炎住院患者的不良结局：一项探索性初步研究
低膈肌厚度可预测COVID-19肺炎住院患者的不良结局：一项探索性初步研究
贵州医科大学 麻醉与心脏电生理课题组
翻译：陈锐 编辑：陈锐 审校：曹莹
本研究的目的是使用超声测量评估膈肌厚度(DT)是否在临床上是一种可行的非侵入性方法，用于识别有不良后果的患者(定义为需要有创机械通气或死亡)的风险。
我们前瞻性地招募了 2020年3月5日至3月30日期间在比萨的中级病房收治的77名实验室确诊的COVID-19感染患者，并随访至出院或死亡。Logistic 回归用于识别可能与不良结果相关的变量，并将那些P<0.10输入到多变量Logistic回归模型中。使用Kaplan-Meier乘积极限估计器，计算低或者不低于基线膈肌肌肉厚度的患者没有不良结果的累积概率。
本研究的主要发现是：（1）出现不良结局的患者的膈肌厚度比未出现不良结局的患者更薄（2.0比2.2毫米，P=0.001）；（2）DT和淋巴细胞计数是不良结局的独立显著预测因子，其中呼气末DT值最大（ß= -708；OR=0.492；P=0.018）。
膈肌超声可能是评估呼吸衰竭风险的有效工具。评估是否需要机械通气治疗不仅应基于 PaO 2 /FiO 2，还应基于包括DT在内的更全面的评估，因为肺顺应性降低，即使没有内在异常的膈肌也可能会变得疲惫，从而使病情发展到严重的呼吸衰竭。
corradi F, isirdi a, Malacarne P , et al., Ucare. low diaphragm muscle mass predicts adverse outcome in patients hospitalized for coviD-19 pneumonia: an exploratory pilot study. Minerva anes-tesiol 2021;87:432-8.Doi:10.23736/s0375-9393.21.15129-6)。
low diaphragm muscle mass predicts adverse outcome in patients hospitalized for coviD-19 pneumonia
ABSTRACT
BACKGROUND: The aim of this study was to evaluate whether measurement of diaphragm thickness (DT) by ultrasonography may be a clinically useful noninvasive method for identifying patients at risk of adverse outcomes defined as need of invasive mechanical ventilation or death.
METHODS: We prospectively enrolled 77 patients with laboratory-confirmed COVID-19 infection admitted to our intermediate care unit in Pisa between March 5 and March 30, 2020, with follow-up until hospital discharge or death. Logistic regression was used identify variables potentially associated with adverse outcomes and those P<0.10 were entered into a multivariate logistic regression model. Cumulative probability for lack of adverse outcomes in patients with or without low baseline diaphragm muscle mass was calculated with the Kaplan-Meier product-limit estimator.
RESULTS: The main findings of this study are that: 1) patients who developed adverse outcomes had thinner diaphragm than those who did not (2.0 vs. 2.2 mm, P=0.001); and 2) DT and lymphocyte count were independent significant predictors of adverse outcomes, with end-expiratory DT being the strongest (ß=-708; OR=0.492; P=0.018).
CONCLUSIONS: Diaphragmatic ultrasound may be a valid tool to evaluate the risk of respiratory failure. Evaluating the need of mechanical ventilation treatment should be based not only on PaO2/FiO2, but on a more comprehensive assessment including DT because if the lungs become less compliant a thinner diaphragm, albeit free of intrinsic abnormality, may become exhausted, thus contributing to severe respiratory failure.
(Cite this article as: Corradi F, Isirdi A, Malacarne P, Santori G, Barbieri G, Romei C, et al., UCARE. Low diaphragm muscle mass predicts adverse outcome in patients hospitalized for COVID-19 pneumonia: an exploratory pilot study. Minerva Anestesiol 2021;87:432-8. DOI: 10.23736/S0375-9393.21.15129-6)
Key words: Diaphragm; Respiratory insufficiency; Ultrasonography.