Abstract: Background　The failure rate of mechanical ventilation weaning is high in elderly patients with sepsis.Although ultrasound has been widely used in the management of critically ill patients in recent years and its evaluation of cardiac and pulmonary function is increasingly used before weaning.However，it is rarely used in the process of weaning in elderly patients with sepsis.Objective　To investigate the predictive value of cardiopulmonary ultrasonography parameters on mechanical ventilation weaning results in elderly patients with sepsis.Methods　A retrospective case-control study was conducted to analyze the clinical data of 60 elderly patients with sepsis admitted to the intensive care unit（ICU） of Cixi Hospital Affiliated to Wenzhou Medical University from January 2013 to October 2018.Patients' basic information，including gender，age，body mass index（BMI），sequential organ failure score（SOFA），acute physiology and chronic health evaluation systemⅡ（APACHE Ⅱ）score，heart rate（HR） before the spontaneous breathing trial（SBT），and mean arterial pressure（MAP） was collected.Patients' underlying diseases and infection sites were also collected.Common predictors of weaning were recorded，including respiratory rate（RR），maximal inspiratory pressure（MIP），mouth occlusion pressure at 0.1s after onset of inspiratory effort（P0.1），and type B natriuretic peptide value（BNP） after SBT test.The rapid shallow breathing index（RSBI） was calculated.The results of cardiac ultrasonography before spontaneous breathing test（SBT） were recorded.Cardiac ultrasonography parameters included left ventricular septal thickness diamete（IVSTD），left ventricular posterior wall thickness diameter（LVPWTD），left ventricular end diastolic diameter（LVDd），left ventricular end systolic diameter（LVDs），mitral peak velocity of early filling（E），mitral peak velocity of late filling（A），and early diastolic mitral annular velocity（E'）．E/A，E/E' were calculated.Systolic left atrial area（LAA） was measured.Left ventricular ejection fraction（LVEF） was also calculated.Pulmonary ultrasonography parameters were lung ultrasound scores（LUS）．According to the results of the weaning，the patients were divided into the weaning success group and the weaning failure group.The differences of the parameters between the patients in the two groups were compared.The predictive value of the cardiopulmonary ultrasonography parameters in elderly patients with sepsis on results of weaning was evaluated with receiver operating characteristic curve（ROC）curve.Results　A total of 60 patients were enrolled，including 35 patients in the weaning success group and 25 patients in the failure group.There were no significant differences in the basic data between the two groups（P>0.05）．The incidence of coronary heart disease in the failure group was higher than that in the success group（P<0.05）．There was no significant difference in infection sites between the two groups（P>0.05）．The RSBI of the weaning failure group was higher than that of the weaning success group（P<0.05）．The cardiac ultrasound parameter E' of the success group was higher than that of the failure group，while the E/E' and the LAA was lower in the success group（P<0.05），and the pulmonary ultrasound parameter LUS was also lower in the success group （P<0.05）．The results of ROC curve analysis showed that E/E'，LUS and LAA had the predictive value for the result of weaning，and the area under curve（AUC） were 0.835，0.751，and 0.680，respectively.When the critical values were E/E'<8.22，LUS<15.50，and LAA<22.85 cm2，the sensitivity were 0.760，0.720，and 0.560，and the specificity were 0.857，0.724，and 0.829，respectively.Conclusion　The parameters of cardiopulmonary ultrasound have the predictive value for the outcome of weaning in elderly patients with sepsis，and the predictive value of the successful weaning in elderly patients with sepsis is high when E/E<8.22，and LUS<15.50 before SBT.

Key words: Ultrasonography；Cardiopulmonary ultrasound；Sepsis；Aged；Weaning；Ventilators, mechanical

摘要： 背景　老年脓毒症患者机械通气撤机失败率高，近年来超声检查广泛应用于重症患者的管理中，临床上越来越多地将超声用于评估患者机械通气撤机前的心、肺功能，但在老年脓毒症患者机械通气撤机过程中超声应用不多。目的　探讨心、肺超声对老年脓毒症患者机械通气撤机结果的预测价值。方法　采用病例对照研究方法，分析2013年1月—2018年10月温州医科大学附属慈溪医院重症监护病房（ICU）收治的60例持续机械通气后撤机的老年脓毒症患者的临床资料。记录患者基本资料，包括性别、年龄、体质指数（BMI）、序贯器官衰竭评分（SOFA）、急性生理学与慢性健康状况评分系统Ⅱ（APACHEⅡ）评分、自主呼吸试验（SBT）前心率（HR）、平均动脉压（MAP）。记录患者的基础疾病及感染部位。记录常见预测撤机指标，包括呼吸频率（RR）、最大吸气压（MIP）、吸气0.1 s口腔闭合压（P0.1）、SBT后B型尿钠肽（BNP）。计算浅快呼吸指数（RSBI）。记录患者在SBT前超声检查结果，心脏超声指标包括：左室舒张末期室间隔厚度（IVSTD）、左心室后壁厚度（LVPWTD）、左心室舒张末期内径（LVDd）、左心室收缩末期内径（LVDs）；舒张早期左房室瓣血流速度（E）、舒张晚期左房室瓣血流速度（A）、舒张早期左房室瓣环运动速度（E'），计算E/A、E/E'；测量收缩期左心房面积（LAA）；计算左心室射血分数（LVEF）。肺部超声指标为肺部超声评分（LUS）。根据撤机结果将患者分为撤机成功组和撤机失败组，比较撤机成功组与撤机失败组各项指标的差异，并采用受试者工作特征（ROC）曲线评估心、肺超声对老年脓毒症患者机械通气撤机结果的预测价值。结果　最终纳入60例患者，其中撤机成功组35例，撤机失败组25例。两组患者基本资料比较，差异均无统计学意义（P>0.05）。撤机失败组基础疾病中的冠心病发生率高于撤机成功组（P<0.05）；两组脓毒症感染部位比较，差异无统计学意义（P>0.05）。撤机失败组RSBI高于撤机成功组（P<0.05）。撤机成功组心脏超声指标E'高于撤机失败组，E/E'、LAA低于撤机失败组（P<0.05），撤机成功组肺部超声指标LUS低于撤机失败组（P<0.05）。ROC曲线分析结果显示，E/E'、LUS、LAA对撤机结果有预测价值，ROC曲线下面积（AUC）分别为0.835、0.751、0.680；当临界值E/E'为8.22、BLUS为15.50分、LAA为22.85 cm2时，灵敏度分别为0.760、0.720、0.560，特异度分别为0.857、0.724、0.829。结论　心肺超声对老年脓毒症患者撤机结果有预测价值，SBT前E/E'为8.22、LUS为15.50分对老年脓毒症患者机械通气撤机成功的预测价值较高。

关键词: 超声检查；心肺超声；脓毒症；老年人；撤机；通气机, 机械