[新型膈肌偏移测量方法的验证研究:通过相控阵探头评估肝肾/脾肾切片中的膈肌偏移]。

Q3 Medicine
Junyu Ma, Shanshan Zhai, Xiaocong Sun, Chen Li, Jun Duan
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引用次数: 0

摘要

目的研究通过肝肾/脾肾切片测量膈肌偏移(DE)的准确性和可重复性,以此作为评估膈肌功能的一种新方法:方法:招募了 12 名健康参与者。方法:招募了 12 名健康参与者,由四名经验不同的操作员分别使用传统方法(肝脏/脾脏切片)和新型方法(肝肾/脾肾切片)进行膈肌外展测量。其中,两名经验丰富的操作员是重症监护临床医生,对 50 多个病例进行了膈肌超声检查。另外两名经验不足的操作者是呼吸治疗师,膈肌超声操作不足 10 例,他们在研究前接受了 2 小时的理论和操作培训。操作员最初使用传统方法,在 M 模式下使用 1.5-6.0 MHz 凸探头,将取样线垂直于膈肌的最大偏移点,在受试者正常呼吸时测定肝/脾切面 DE。然后,他们采用新方法,使用 1.6-4.5 MHz 相控阵探头沿腋中线观察膈肌的颅内运动,采用解剖 M-模式,将取样线垂直于肾中点水平的膈肌,在正常呼吸时测量肝肾/脾肾切面的 DE。肝脏和肝肾切片用于评估右侧膈肌,脾脏和脾肾切片用于评估左侧膈肌。采用戴明法对不同切片的膈肌测量值进行相关性分析,并采用布兰-阿尔特曼法评估一致性。临床可接受性的一致性定义为没有固定偏差和比例偏差,两个标准差小于平均测量值的 40%。一致性限值百分比=测量值/平均测量值的两个标准差×100%:四名操作者分别对12名受试者的四个切面进行了DE图像扫描,肝肾切面和脾肾切面的DE采集率高达100%(48/48),其次是肝脏切面[91.7%(44/48)]和脾脏切面[66.7%(32/48)],尤其是在左侧膈肌评估中,脾肾切面的DE采集率明显高于传统脾脏切面(P<0.01)。总体测量结果显示,使用新方法通过肝肾切片和脾肾切片确定的 DE 无明显差异(cm:1.64±0.10 vs. 1.55±0.14,P > 0.05),且明显高于传统肝脏和脾脏切片的测定值(cm:肝-肾切片对肝切片的测定值为 1.64±0.10 对 1.44±0.09,脾-肾切片对脾切片的测定值为 1.55±0.14 对 1.09±0.14,均 P <0.01)。相关性分析显示,肝肾切片与脾肾切片之间、肝脏切片与肝肾切片之间、肝脏切片与脾肾切片之间的DE相关性良好(r值分别为0.62、0.59和0.42,均P<0.01)。一致性分析表明,肝-肾切片与脾-肾切片之间以及肝切片与肝-肾切片之间的DE一致性良好(一致性限均小于40%)。然而,脾脏切片与其他三个切片所测得的 DE 值没有相关性,也没有不一致性(所有百分比一致性限值均大于 40%)。四位操作者在肝脏、脾脏、肝肾和脾肾切片中测量的 DE 差异无统计学意义(厘米:肝脏切片为 1.49±0.34、1.44±0.37、1.43±0.30 和 1.40±0.27;肝肾切片为 1.10±0.36、1.05±0.36 和 1.40±0.27)。36、1.05±0.18、1.09±0.22 和 1.06±0.26;肝肾切片 1.67±0.43、1.57±0.34、1.63±0.32 和 1.66±0.36;脾肾切片 1.45±0.33、1.48±0.34、1.50±0.24 和 1.65±0.26;所有 P >0.05)。根据临床可接受的一致性限值范围,四位操作者在所有四个切片中测量的 DE 均显示出良好的一致性(所有一致性限值均小于 40%):通过肝-肾/脾-肾切片测量 DE 的新方法准确、可重复性高、采集率高,是肝/脾切片传统方法的可行替代方法。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
[Validation study of a novel diaphragmatic excursion measurement method: evaluation of diaphragmatic excursion by phased-array probe in hepato-renal/spleno-renal section].

Objective: To investigate the accuracy and reproducibility of diaphragmatic excursion (DE) measurements through hepato-renal/spleno-renal section as a novel method for assessing diaphragmatic function.

Methods: Twelve healthy participants were recruited. Each participant underwent DE measurements performed by four operators with varying levels of experience using traditional methods (liver/spleen section) and novel methods (hepato-renal/spleno-renal section), respectively. Among them, two experienced operators were critical care clinicians, and diaphragmatic ultrasound was performed in more than 50 cases. The other two inexperienced operators were respiratory therapists, with less than 10 cases of diaphragmatic ultrasound operations, who received a 2-hour theoretical and operational training before the study. Operators initially used the conventional method with a 1.5-6.0 MHz convex probe in M-mode, placing the sampling line perpendicular to the diaphragm at the point of maximum excursion, and the liver/spleen section DE was determined during normal breathing of participant. Then, they used the novel method with a 1.6-4.5 MHz phased array probe to observe diaphragmatic movement cranio-caudally along the mid-axillary line, employing anatomic M-mode with the sampling line placed perpendicular to the diaphragm at the level of the renal midpoint, and the DE of the hepato-renal/spleno-renal section was measured during normal breathing. The liver and hepato-renal sections were used to assess the right diaphragm, and spleen and spleno-renal sections were used to assess the left diaphragm. Correlation analysis of DE measurements from different sections was conducted using the Deming method, while consistency was assessed using the Bland-Altman method. The consistency of clinical acceptability was defined as the absence of fixed and proportional bias, with a difference of two standard deviations less than 40% of the mean measurement value. Percentage consistency limit = two standard deviations of the differences between measurements/mean measurement value×100%.

Results: Four operators performed image scans of DE in all four sections for each of the twelve subjects, with a high DE acquisition rate of 100% (48/48) for hepato-renal and spleno-renal sections, followed by the liver section [91.7% (44/48)] and the spleen section [66.7% (32/48)], particularly for the left diaphragm assessment, where the DE acquisition rate of spleno-renal section was significantly higher than that of traditional spleen section (P < 0.01). The overall measurement results showed that no significant difference was found in DE determined via the hepato-renal and spleno-renal sections using the novel method (cm: 1.64±0.10 vs. 1.55±0.14, P > 0.05), and they were significantly higher than those determined via the conventional liver and spleen sections (cm: hepato-renal section vs. liver section was 1.64±0.10 vs. 1.44±0.09, spleno-renal section vs. spleen section was 1.55±0.14 vs. 1.09±0.14, both P < 0.01). Correlation analysis revealed good correlations of DE between hepato-renal section and spleno-renal section, between liver section and hepato-renal section, between liver section and spleno-renal section (r values were 0.62, 0.59, and 0.42, all P < 0.01). Consistency analysis showed that the consistency in DE between hepato-renal section and spleno-renal section, as well as between liver section and hepato-renal section was good (both % consistency limits < 40%). However, the DE measured in the spleen section were not correlated with the other three sections, and there was no inconsistency (all % consistency limits > 40%). There was no statistically significant difference in DE measured by the four operators in the liver, spleen, hepato-renal, and spleno-renal sections (cm: 1.49±0.34, 1.44±0.37, 1.43±0.30, and 1.40±0.27 in liver section; 1.10±0.36, 1.05±0.18, 1.09±0.22, and 1.06±0.26 in spleen section; 1.67±0.43, 1.57±0.34, 1.63±0.32, and 1.66±0.36 in hepato-renal section; 1.45±0.33, 1.48±0.34, 1.50±0.24, and 1.65±0.26 in spleno-renal section; all P > 0.05). According to the clinically acceptable range of consistency limits, the DE measured by the four operators in all four sections showed good consistency (all % consistency limits < 40%).

Conclusions: The novel method of measuring DE through hepato-renal/spleno-renal sections is accurate, highly reproducible, and has a high acquisition rate, serving as a viable alternative to the conventional method involving the liver/spleen section.

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来源期刊
Zhonghua wei zhong bing ji jiu yi xue
Zhonghua wei zhong bing ji jiu yi xue Medicine-Critical Care and Intensive Care Medicine
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