内科

目的探讨重症肺炎机械通气患者发生呼吸机相关膈肌功能障碍（VIDD）的相关因素，为识别高危患者提供初步依据。方法采用回顾性队列研究设计，连续纳入2021年1月至2024年3月广西中医药大学附属瑞康医院重症医学科收治的261例重症肺炎机械通气患者。根据膈肌超声诊断标准，将患者分为VIDD组（n=110）与非VIDD组（n=151）。收集患者入院基线资料及治疗相关变量。采用单因素分析比较组间差异，并运用LASSO回归筛选变量，进而将筛选出的变量纳入多因素logistic回归模型，分析其与VIDD发生的相关性。结果 VIDD发生率为42.15%（110/261）。单因素分析显示，两组在急性生理与慢性健康状况评价 Ⅱ（APACHE Ⅱ）评分、血清白蛋白、淋巴细胞计数、性别、呼气末正压（PEEP）水平、治疗前动脉氧分压（PaO2）及是否进行早期功能锻炼等方面差异有统计学意义（均P<0.05）。LASSO回归筛选出4个核心变量。多因素logistic回归分析显示，入院时APACHE Ⅱ评分较高（OR=1.174， 95%CI： 1.046～1.317）与PEEP异常（OR=2.354， 95%CI：1.309～4.234）与VIDD发生呈正相关（均P<0.05）；血清白蛋白水平较高（OR=0.943，95%CI：0.894～0.995）与进行早期功能锻炼（OR=0.389，95%CI：0.221～0.686）与VIDD发生呈负相关（均P<0.05）。结论在重症肺炎机械通气患者中，入院时较高的病情严重程度（APACHE Ⅱ评分）与异常的PEEP与VIDD发生风险增加相关，而入院时较高的血清白蛋白水平及进行早期功能锻炼则与风险降低相关。临床工作中应对具有上述特征的患者加强膈肌功能监测。

Objective To investigate the factors associated with ventilator-induced diaphragmatic dysfunction (VIDD) in mechanically ventilated patients with severe pneumonia, providing preliminary evidence for identifying high-risk patients. Methods A retrospective cohort study was conducted. A total of 261 patients with severe pneumonia undergoing mechanical ventilation and admitted to the Intensive Care Unit of Ruikang Hospital Affiliated to Guangxi University of Chinese Medicine from January 2021 to March 2024 were enrolled. Based on diaphragmatic ultrasound diagnostic criteria, patients were divided into the VIDD group (n=110) or the non-VIDD group (n=151). Baseline data on admission and treatment-related variables of the patients were collected. Univariate analysis was used to compare intergroup differences, and LASSO regression was employed to screen variables; subsequently, the selected variables were incorporated into a multivariate logistic regression model to analyze their correlation with VIDD occurrence. Results The incidence of VIDD was 42.15% (110/261). Univariate analysis showed statistically significant differences between the two groups in Acute Physiology and Chronic Health Evaluation Ⅱ (APACHE Ⅱ) score, serum albumin level, lymphocyte count, gender, positive end-expiratory pressure (PEEP) level, pre-treatment arterial oxygen partial pressure (PaO2), and whether early functional exercise was performed (all P<0.05). LASSO regression identified 4 core variables. Multivariate logistic regression analysis revealed that higher APACHE Ⅱ score on admission(OR=1.174, 95%CI: 1.046-1.317) and abnormal PEEP (OR=2.345, 95%CI: 1.309-4.234) were positively correlated with VIDD occurrence (all P<0.05), while higher serum albumin level (OR=0.943, 95%CI: 0.894-0.995) and early functional exercise (OR=0.389, 95%CI: 0.221-0.686) were negatively correlated with VIDD occurrence (all P<0.05). Conclusion In patients with severe pneumonia undergoing mechanical ventilation, higher disease severity (APACHE Ⅱ score) on admission and abnormal PEEP are associated with an increased risk of VIDD. Conversely, a higher serum albumin level at admission and the implementation of early functional exercise are associated with a reduced risk. Therefore, enhanced monitoring of diaphragmatic function is recommended for patients with these risk profiles in clinical practice.