CN114983469A - Method and device for respiratory drive assessment by using ultrasound - Google Patents
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Abstract
The invention discloses a method and a device for respiratory drive assessment by utilizing ultrasound, and relates to the technical field of medical treatment. The method utilizes bedside ultrasound to measure the diaphragm displacement, the diaphragm thickening rate and the inferior vena cava dilatation rate, and utilizes the diaphragm displacement, the diaphragm thickening rate and the inferior vena cava dilatation rate to evaluate the occurrence of respiratory hyperactuation of a measured person. The ultrasonic image of the inferior vena cava can assist in judging whether the driving pressure increase is the spontaneous respiration driving increase or the parameter setting of the breathing machine is overhigh; the combination of the two can realize the identification and classification of the high drive of the early respiration of people with severe symptoms. Meanwhile, the method and the device of the invention are not only suitable for mechanical ventilators, but also suitable for the identification and classification of the early breath high drive of the ventilators without mechanical ventilators, and can effectively solve the problem that the breath high drive of the ventilators which are incapable of identifying and retaining spontaneous breath in early stage.
Description
Technical Field
The invention relates to the technical field of medical treatment, in particular to a method and a device for evaluating respiratory drive by utilizing ultrasound.
Background
Respiratory failure is a common complication in critically ill patients, and mechanical ventilation is a common support for respiratory failure patients. In the early stage of respiratory failure, respiratory high-drive manifestations mainly including tidal volume increase and respiratory frequency increase often appear; the occurrence of ventilator-related lung injury is easily caused by improper parameter setting in the mechanical ventilation process; both are the main causes of severe patient lung injury, and the essence is that the driving pressure increases or exceeds normal values leading to acute lung injury affecting the lung parenchyma.
As published in "journal of china" 2016 at 1/5/2016 at 96/1 st volume, entitled "ventilator-associated lung injury and driving pressure", published in 5/1/2016 in 5/2016, the authors are shown in the literature by wu xiao jing, xiajin gen, jensengyuan: in diseased lung tissue, respiratory compliance may be better able to predict functional residual capacity than ideal body weight. The variability of functional residual capacity among different patients determines that the driving pressure better predicts lung strain and survival rate than tidal volume based on ideal body weight. According to a calculation formula, the driving pressure can be easily monitored at the bedside, so that the driving pressure is feasible and effective for guiding clinical practice. Airway driving pressure can be affected by chest wall compliance, and monitoring of cross-lung driving is of greater clinical value. At present, the respiratory compliance cannot be directly measured, so that the driving pressure can be obtained only through the platform pressure and PEEP calculation, but the calculation formula is only suitable for patients without spontaneous respiration. The driving pressure cannot be applied to a patient who retains spontaneous breathing.
As can be seen from the above, the methods that can be used to evaluate respiratory drive are limited to mechanically ventilated patients, including tidal volume, transpulmonary pressure, and oral blocking pressure, which are limited by the number of factors and cannot be used to evaluate patients with non-mechanical ventilation. How to early identify the occurrence of respiratory hyperactuation and the prevention and treatment of the harm caused by the respiratory hyperactuation becomes a hot topic in the field of severe research.
Disclosure of Invention
In order to overcome the defects and shortcomings in the prior art, the invention provides a method and a device for respiratory drive assessment by using ultrasound. The invention aims to solve the problem that the driving pressure cannot be applied to the person keeping spontaneous breathing in the prior art and further solve the problem that the high driving of the breathing of the person keeping spontaneous breathing cannot be recognized early. The method utilizes bedside ultrasound to measure diaphragmatic muscle displacement, the diaphragm thickening rate and the inferior vena cava variation rate, and utilizes the diaphragm displacement, the diaphragm thickening rate and the inferior vena cava variation rate to evaluate the occurrence of respiratory hyperdrive. The diaphragm ultrasonic can partially reflect the respiratory drive state, and the ultrasonic image of the inferior vena cava can assist in judging whether the drive pressure is increased by the spontaneous respiratory drive or the parameter setting of the breathing machine is overhigh; the combination of the two can realize the identification and classification of early respiration high drive. Meanwhile, the method and the device of the invention are not only suitable for mechanical ventilators, but also suitable for the identification and classification of the early breath high drive of the ventilators without mechanical ventilators, and can effectively solve the problem that the breath high drive of the ventilators which remain spontaneous breath cannot be identified in early stage.
In order to solve the problems in the prior art, the invention is realized by the following technical scheme.
In a first aspect, the present invention provides a method for respiratory drive assessment using ultrasound, the method comprising the steps of:
s1, monitoring the diaphragm position of the tested person by using ultrasonic equipment, capturing the diaphragm motion state of the tested person during expiration and inspiration, and acquiring the diaphragm state change ultrasonic images during expiration and inspiration;
s2, monitoring the position of the inferior vena cava of the tested person by using ultrasonic equipment, capturing the motion state of the inferior vena cava of the tested person during expiration and inspiration, and acquiring the state change ultrasonic images of the inferior vena cava during expiration and inspiration;
s3, identifying the diaphragm muscle state change ultrasonic image and the inferior vena cava state change ultrasonic image obtained in the steps S1 and S2 by using an AI identification tool; analyzing and processing the content of the ultrasonic image, measuring and calculating to obtain the diaphragm motion parameters and inferior vena cava state parameters of the tested person during expiration and inspiration;
and S4, comparing the diaphragm motion parameters and the inferior vena cava state parameters obtained in the step S3 with diaphragm motion parameter setting thresholds and inferior vena cava state parameter setting thresholds respectively, and evaluating and classifying the respiratory drive of the tested person according to the comparison result.
Further preferably, the diaphragm motion parameter includes diaphragm mobility; the inferior vena cava state parameters comprise inferior vena cava respiratory variability; the diaphragm motion parameter setting threshold comprises a diaphragm movement degree threshold; the inferior vena cava state parameter setting threshold comprises an inferior vena cava respiratory variability threshold.
Still further preferably, the diaphragm movement parameter further includes a diaphragm thickening rate, and the diaphragm movement parameter setting threshold further includes a diaphragm thickening rate threshold.
Still further preferably, the degree of respiratory variability of the inferior vena cava comprises IVC collapse rate or IVC expansion rate;
the IVC collapse rate is calculated under the autonomous respiration mode of the tested person, and the calculation formula is
IVC collapse rate = (IVC end-expiratory diameter-IVC end-inspiratory diameter)/IVC end-expiratory diameter 100%;
the IVC expansion rate is calculated under the condition that the tested person does not have the spontaneous respiration mode, and the calculation formula is
IVC expansion rate = (IVC end-inspiratory diameter-IVC end-expiratory diameter)/IVC end-expiratory diameter 100%.
Still further preferably, the lower vena cava respiratory variability threshold comprises an IVC collapse rate threshold or an IVC expansion rate threshold.
Further preferably, in the step S1, the ultrasonic images of diaphragm state changes obtained when the person to be tested exhales and inhales include an ultrasonic image of diaphragm displacement changes and an ultrasonic image of diaphragm thickening rate changes.
More preferably, the ultrasonic image of the diaphragm displacement change is obtained by using an ultrasonic probe, wherein a marking point of the ultrasonic probe faces to the inner side and slides from the abdomen of the tested person to the position below the costal margin to expose the diaphragm top; recording ultrasonic images of diaphragm displacement changes in at least 3 respiratory cycles in a B ultrasonic mode, and storing an kinegram; and then switches to M mode.
Further preferably, in step S3, the AI identification tool identifies the ultrasonic image of diaphragm displacement change, and calculates the maximum displacement value of a fixed point in each respiratory cycle; and obtaining an average displacement value of a plurality of respiratory cycles as the diaphragm muscle movement degree of the tested person.
Further preferably, the convex array probe is used for monitoring during the acquisition process of the ultrasonic image of the diaphragm displacement change.
Preferably, the ultrasonic image of the change of the thickening rate of the diaphragm muscle is obtained by sliding the ultrasonic probe along the axillary midline of the person to be tested from the abdomen to the chest, rotating the ultrasonic probe along the intercostal space at the position where the curtain sign appears, fully exposing the diaphragm muscle, recording the ultrasonic image of the change of the thickness of the diaphragm muscle in at least 3 respiratory cycles, and storing the motion picture; and switching to an M mode for calculation.
Further preferably, in step S3, the AI identification tool identifies the ultrasonic image of diaphragm thickness variation, calculates the maximum thickness and the minimum thickness of a certain fixed point in each respiratory cycle, and calculates the thickening rate; and obtaining the average maximum thickness, the average minimum thickness and the average thickening rate of the fixed point positions in a plurality of respiratory cycles, and taking the obtained average thickening rate as the diaphragm thickening rate of the tested person.
The calculation formula of the diaphragm muscle thickening rate is
Diaphragm muscle thickening rate = (end inspiratory thickness-end expiratory thickness)/end expiratory thickness 100%.
Further preferably, the linear array probe is used for monitoring in the process of acquiring the ultrasonic image of the diaphragm thickening rate change.
Further preferably, in the step S2, the mode of acquiring the ultrasound image of the change of the inferior vena cava state when the person being tested exhales and inhales includes two types, one of the two types is acquired by the xiphoid process, and the other is acquired by the posterior axillary line of the liver.
Further preferably, the inferior vena cava inferior acquisition mode may display two sectional images of the inferior vena cava, namely, a long axis section of the inferior vena cava and a short axis section of the inferior vena cava, and one of the two sectional images may be optionally selected for acquisition when the ultrasound image of the inferior vena cava state change is acquired.
Further preferably, the evaluation and classification of the respiratory drive of the person to be tested according to the comparison result specifically means,
the method comprises the steps that the diaphragm movement degree of a mechanical ventilation tested person in a spontaneous breathing mode is larger than a diaphragm movement degree threshold, the diaphragm thickening rate is larger than a diaphragm thickening rate threshold, and meanwhile, if the IVC state is inspiration collapse, the evaluation is that the mechanical ventilation tested person is high-driving of spontaneous breathing;
the method comprises the steps that the diaphragm movement degree of a mechanical ventilation tested person in a spontaneous breathing mode is larger than a diaphragm movement degree threshold, the diaphragm thickening rate is smaller than or equal to a diaphragm thickening rate threshold, and meanwhile, if the IVC state is inspiration collapse, the evaluation is that the mechanical ventilation tested person is high-driving of spontaneous breathing;
the diaphragm movement degree of a mechanical ventilation tested person without spontaneous respiration is larger than a diaphragm movement degree threshold, the diaphragm thickening rate is smaller than or equal to a diaphragm thickening rate threshold, and meanwhile, if the IVC state is inspiration expansion, the breathing parameter setting of the breathing machine is evaluated to be too high;
and under the complete spontaneous breathing mode, the tested person does not have mechanical ventilation, the diaphragm movement degree is greater than the diaphragm movement degree threshold, the diaphragm thickening rate is greater than the diaphragm thickening rate threshold, and meanwhile, if the IVC state is inspiration collapse, the evaluation is that the spontaneous breathing is high-driving.
In a second aspect, the present invention provides an apparatus for respiratory drive assessment using ultrasound, the apparatus comprising:
the ultrasonic image acquisition module is used for establishing data transmission connection with the ultrasonic equipment and receiving a diaphragm state change ultrasonic image and an inferior vena cava state change ultrasonic image which are acquired by the ultrasonic equipment;
the AI identification module is used for identifying the ultrasonic image of the diaphragm muscle state change and the ultrasonic image of the inferior vena cava state change obtained by the ultrasonic image acquisition module; analyzing and processing the content of the ultrasonic image, measuring and calculating to obtain the diaphragm motion parameters and inferior vena cava state parameters of the tested person during expiration and inspiration;
and the respiratory drive evaluation and classification module is used for comparing the diaphragm motion parameter and the inferior vena cava state parameter obtained by combining the AI identification module with a diaphragm motion parameter setting threshold and an inferior vena cava state parameter setting threshold respectively, and evaluating and classifying the respiratory drive of the tested personnel according to the comparison result.
Further preferably, the device further comprises an early warning feedback module, wherein the early warning feedback module sends out early warning feedback information according to the evaluation and classification results of the respiration driving evaluation and classification module.
Compared with the prior art, the beneficial technical effects brought by the invention are as follows:
1. the diaphragm muscle ultrasonic can partially reflect the respiratory driving state of a tested person, and the ultrasonic image of the inferior vena cava can assist in judging whether the driving pressure is increased by spontaneous respiratory driving or the parameter setting of a breathing machine is overhigh; the combination of the two can realize the identification and classification of the early breath high drive of the tested person. Meanwhile, the method and the device of the invention are not only suitable for mechanical ventilators, but also suitable for the identification and classification of the early respiratory high drive of non-mechanical ventilators, and can effectively solve the problem that the respiratory high drive of the ventilators which can not identify and retain spontaneous breath in early stage.
2. The invention can fill the blank in the aspect of prevention and research for early identifying the occurrence of respiratory high drive and the harm caused by the respiratory high drive by utilizing ultrasound, and solve the problem that the drive pressure cannot be applied to the personnel keeping autonomous respiration. The method and the device are not only suitable for mechanical ventilators, but also more suitable for respiratory high-drive evaluation of spontaneous breathers.
3. Under the monitoring of diaphragmatic muscle supersound, the diaphragm mobility is higher than the threshold value and can be judged for the driving pressure increase when surveyed personnel spontaneous breathing, but can't judge the reason that the driving pressure increases for the spontaneous breathing is too strong to lead to or the breathing machine parameter sets up too high to lead to. When the tested person breathes autonomously, the thickening rate of the diaphragm muscle is higher than the threshold value, and the respiratory drive is judged to be enhanced, and when the mechanical ventilation is completed, the thickening rate of the diaphragm muscle is reduced. The incidence rate of severe people VIDD (ventilator-associated diaphragmatic dysfunction) is extremely high, and diaphragmatic ultrasonography shows that the displacement and thickening rate are reduced in different degrees, so that a clinician cannot be assisted to recognize the occurrence of high respiratory drive and the harm caused by the high respiratory drive in early stage only by diaphragmatic ultrasonography. The inferior vena cava is the largest vein trunk in the body, the veins of the lower half body are collected and returned to the right atrium, and the inner diameter of the inferior vena cava and the central venous pressure are in positive linear correlation on the premise of no abdominal high pressure. Therefore, in the invention, the diaphragm ultrasonic can partially reflect the respiratory driving state of the tested person, and the ultrasonic image of the inferior vena cava can assist in judging whether the driving pressure increase is the driving increase caused by spontaneous respiration or the driving increase caused by overhigh parameter setting of a breathing machine; the combination of the two can realize the identification and classification of the early breath high drive of the tested person.
4. The respiratory drive evaluation device carries out ultrasonic examination on a person to be tested needing to closely monitor respiratory drive, obtains images of diaphragm muscles and inferior vena cava, inputs the images into an ultrasonic image acquisition module, transmits the obtained ultrasonic images into an AI identification module by the ultrasonic image acquisition module, carries out typing and analysis on the ultrasonic images by the AI identification module, then inputs the images into the respiratory drive evaluation and classification module to output respiratory drive evaluation and classification results of the person to be tested, and finally sends early warning feedback information by an early warning feedback module to remind medical personnel to intervene the person to be tested with respiratory drive symptoms.
5. For mechanical ventilators and non-mechanical ventilators in a spontaneous breathing mode, the thickening rate of the diaphragm does not participate in the evaluation of breathing drive, only if the mechanical ventilators are fully mechanical ventilators without spontaneous breathing, the thickening rate of the diaphragm participates in the evaluation of breathing drive, and the thickening rate of the diaphragm is mainly used for evaluating the condition that the breathing parameter setting of the breathing machine is too high, so that medical staff can reduce the breathing machine support parameter as soon as possible to improve the breathing height drive of a tested person.
Drawings
FIG. 1 is a flow chart of a method of breath-driven assessment using ultrasound according to the present invention;
FIG. 2 is a schematic diagram of the acquisition of an ultrasonic image of diaphragm displacement variation;
FIG. 3 is a schematic diagram of diaphragm displacement variation;
FIG. 4 is a diaphragmatic muscle ultrasound image;
FIG. 5 is an ultrasound image of diaphragm displacement change;
FIG. 6 is a schematic diagram of ultrasonic image acquisition of the change of the thickening rate of the diaphragm muscle;
FIG. 7 is a schematic diagram of diaphragm thickness variation;
FIG. 8 is a diaphragm thickness ultrasound image;
FIG. 9 is an ultrasound image of diaphragm thickness variation;
FIG. 10 is a longitudinal section ultrasonic image of the inferior vena cava obtained from the measured person in the spontaneous respiration state;
FIG. 11 is an ultrasonic image of a minor axis section of the inferior vena cava at the end of inspiration obtained when a person under test is in a spontaneous breathing state;
fig. 12 is an ultrasonic image of the short-axis section of the end-expiratory inferior vena cava obtained with the person under test breathing spontaneously.
Detailed Description
The technical solutions in the embodiments of the present invention will be clearly and completely described below with reference to the drawings in the specification of the present invention, and it is obvious that the described embodiments are only a part of the embodiments of the present invention, and not all of the embodiments. All other embodiments, which can be derived by a person skilled in the art from the embodiments given herein without making any creative effort, shall fall within the protection scope of the present invention.
Referring to fig. 1, a method for performing expiratory drive assessment using ultrasound is provided as a preferred embodiment of the present invention, the method comprising the steps of:
s1, monitoring the diaphragm position of the tested person by using ultrasonic equipment, capturing the diaphragm motion state of the tested person during expiration and inspiration, and acquiring the diaphragm state change ultrasonic images during expiration and inspiration;
s2, monitoring the position of the inferior vena cava of the tested person by using ultrasonic equipment, capturing the motion state of the inferior vena cava of the tested person during expiration and inspiration, and acquiring the state change ultrasonic images of the inferior vena cava during expiration and inspiration;
s3, identifying the diaphragm muscle state change ultrasonic image and the inferior vena cava state change ultrasonic image obtained in the steps S1 and S2 by using an AI identification tool; analyzing and processing the content of the ultrasonic image, measuring and calculating to obtain the diaphragm motion parameters and inferior vena cava state parameters of the tested person during expiration and inspiration;
and S4, comparing the diaphragm motion parameters and the inferior vena cava state parameters obtained in the step S3 with diaphragm motion parameter setting thresholds and inferior vena cava state parameter setting thresholds respectively, and evaluating and classifying the respiratory drive of the tested person according to the comparison result.
As an implementation manner of this embodiment, the step S1 and the step S2 are not consecutive, and the acquisition order of the ultrasound images may be adaptively adjusted according to actual situations, for example, the ultrasound images of diaphragm muscle state changes are acquired first, and then the ultrasound images of inferior vena cava state changes are acquired; or firstly acquiring the ultrasound image of the change of the inferior vena cava state and then acquiring the ultrasound image of the change of the diaphragm muscle state.
The step S3 may be performed in real time according to the acquisition conditions of the ultrasonic image of the diaphragm state change and the ultrasonic image of the inferior vena cava state, and when the acquisition of the ultrasonic image of the diaphragm state change is completed, AI identification may be performed on the acquired ultrasonic image of the diaphragm state change, that is, the identification of the ultrasonic image of the diaphragm state change in the step S3 may be performed synchronously with the step S2; the order of AI identification may also be adjusted after the sequence of acquiring ultrasound images changes. For example: after the collection of the ultrasonic image of the diaphragm muscle state change is completed, AI identification of the ultrasonic image of the diaphragm muscle state change is carried out, and meanwhile, the ultrasonic image of the inferior vena cava state change is collected; or the acquisition of the ultrasound image of the inferior vena cava state change is completed firstly, namely AI identification of the ultrasound image of the inferior vena cava state change can be carried out, and meanwhile, the ultrasound image of the diaphragm muscle state change is acquired; or after the diaphragm muscle state change ultrasonic image and the inferior vena cava state change ultrasonic image are completely collected, AI identification is carried out on the diaphragm muscle ultrasonic image and the inferior vena cava ultrasonic image respectively.
In yet another embodiment of this embodiment, the diaphragm movement parameter includes diaphragm movement degree; the inferior vena cava state parameters comprise inferior vena cava respiratory variability; the diaphragm motion parameter setting threshold comprises a diaphragm movement degree threshold; the inferior vena cava state parameter setting threshold comprises an inferior vena cava respiratory variability threshold.
Under diaphragmatic muscle ultrasonic monitoring, when surveyed personnel spontaneous breathing diaphragmatic muscle mobility is higher than the threshold value and can judge for the drive pressure increases, it can't judge that the drive pressure increases to lead to or the breathing machine parameter sets up too high for spontaneous breathing too strongly to lead to singly, consequently, diaphragmatic muscle ultrasonic can partly reflect surveyed personnel breathing drive state, and the ultrasonic image of inferior vena cava can assist and judge whether the drive pressure increases because spontaneous breathing drive increases or the breathing machine parameter sets up too high, it can realize discernment and classification to the severe surveyed personnel high drive of breathing in early stage to have combined the two.
Further, the threshold for diaphragm movement is set as shown in table 1 below:
TABLE 1 diaphragmatic muscle mobility during normal breathing
Further, the inferior vena cava respiratory variability comprises IVC collapse rate or IVC expansion rate.
During spontaneous breathing, inspiration is realized, and the intrathoracic pressure is reduced; contraction of diaphragm-downward movement-decrease of right atrial pressure; increased abdominal pressure-increased venous return-collapsed inferior vena cava; the IVC collapse rate is calculated under the autonomous respiration mode of the tested person, and the calculation formula is IVC collapse rate = (IVC end-inspiration)/IVC end-expiration 100%; normal values > 50%.
In the absence of spontaneous respiration and in positive pressure ventilation, alveolar expansion, intrathoracic pressure increase, right atrial pressure increase, venous return reduction and inferior vena cava expansion are carried out, the IVC expansion rate is calculated under the mode that a tested person does not breathe spontaneously, and the IVC expansion rate is calculated by the formula of IVC expansion rate = (IVC end-expiratory)/IVC end-expiratory rate 100 percent, and the normal value is more than 18 percent.
As a further implementation manner of this embodiment, the diaphragm movement parameter further includes a diaphragm thickening rate, and the diaphragm movement parameter setting threshold further includes a diaphragm thickening rate threshold. When the tested person breathes autonomously, the thickening rate of the diaphragm muscle is higher than the threshold value, and the respiratory drive is judged to be enhanced, and the thickening rate of the diaphragm muscle is reduced when the mechanical ventilation is completed. The incidence rate of severe person VIDD (ventilator-associated diaphragmatic dysfunction) is extremely high, and diaphragmatic ultrasonic can be expressed as the decrease of displacement and thickening rate in different degrees. Therefore, the diaphragm thickening rate is introduced in the embodiment to assist the respiratory drive evaluation of the tested person who breathes spontaneously and has no mechanical ventilation.
Further, the diaphragm muscle thickening rate is calculated by the formula of diaphragm muscle thickening rate = (end inspiration thickness-end expiration thickness)/end expiration thickness 100%, wherein the normal diaphragm muscle thickness, the diaphragm muscle thickening rate and the parameter values of the diaphragm muscle atrophy state are shown in the following table 2:
table 2 shows the values of normal diaphragm thickness, diaphragm thickening rate and diaphragm atrophy
As an implementation manner of this embodiment, in step S4, the evaluation and classification of respiratory drive of the person to be tested according to the comparison result specifically means,
the diaphragmatic muscle mobility of the mechanical ventilator in the spontaneous breathing mode is larger than a diaphragmatic muscle mobility threshold, the diaphragm thickening rate is larger than a diaphragm thickening rate threshold, and meanwhile, if the IVC state is inspiration collapse, the evaluation is that the spontaneous breathing is high-driven; the diaphragmatic muscle mobility of the mechanical ventilator in the spontaneous breathing mode is larger than a diaphragmatic muscle mobility threshold, the diaphragm thickening rate is smaller than a diaphragm thickening rate threshold, and meanwhile, if the IVC state is inspiration collapse, the evaluation is that the spontaneous breathing is high-driven; the diaphragmatic muscle mobility of a mechanical ventilator without spontaneous respiration is larger than a diaphragmatic muscle mobility threshold, the diaphragm thickening rate is smaller than a diaphragm thickening rate threshold, and meanwhile, if the IVC state is inspiration expansion, the ventilator ventilation parameter is evaluated to be set too high; and no mechanical ventilator exists in the complete spontaneous breathing mode, the diaphragm movement degree is greater than the diaphragm movement degree threshold, the diaphragm thickening rate is greater than the diaphragm thickening rate threshold, and meanwhile, the IVC state is inspiration collapse, and then the spontaneous breathing high drive is evaluated. The details are shown in the following table 3:
table 3 shows the results of respiratory drive assessment and classification
As can be seen from table 3 above, for mechanical ventilators and non-mechanical ventilators in the spontaneous breathing mode, the diaphragm thickening rate does not participate in the evaluation of the breathing drive, and only if there is no complete mechanical ventilators for spontaneous breathing, the diaphragm thickening rate participates in the evaluation of the breathing drive, and the diaphragm thickening rate is also mainly used for evaluating the condition that the breathing parameter of the ventilator is set too high, so that medical staff can reduce the ventilator support parameter as soon as possible, and the breathing drive of the measured staff can be improved.
As another implementation manner of this embodiment, in the step S1, the obtained ultrasonic images of changes in diaphragm muscle state when the person being tested exhales and inhales include an ultrasonic image of changes in diaphragm muscle displacement and an ultrasonic image of changes in diaphragm muscle thickening rate.
As shown in fig. 2 and 3, the ultrasonic image of diaphragm displacement change is obtained by using an ultrasonic probe, wherein the marking point of the ultrasonic probe faces to the inner side and slides from the abdomen of the person to be tested to the lower part of the costal margin to expose the diaphragm top; recording ultrasonic images of diaphragm displacement changes in at least 3 respiratory cycles in a B ultrasonic mode, and saving the kinegrams; and then switches to M mode. As shown in fig. 4 and 5, the AI identification tool identifies the ultrasonic image of diaphragm displacement change, and calculates the maximum displacement value of a certain fixed point in each respiratory cycle; and obtaining the average displacement value of a plurality of respiratory cycles as the diaphragm movement degree of the tested person.
Further preferably, the convex array probe is used for monitoring in the process of acquiring the ultrasonic image of the diaphragm displacement change.
As shown in fig. 6 and 7, the ultrasonic image of the change in the thickening rate of the diaphragm muscle is obtained specifically by sliding the ultrasonic probe along the axillary midline of the person to be tested from the abdomen to the chest, rotating the ultrasonic probe along the intercostal space where the curtain marks appear, fully exposing the diaphragm muscle, recording the ultrasonic image of the change in the thickness of the diaphragm muscle in at least 3 respiratory cycles, and storing the moving image; and switching to an M mode for calculation. As shown in fig. 8 and 9, the AI identification tool identifies the ultrasonic image of the diaphragm thickness variation, calculates the maximum thickness and the minimum thickness of a certain fixed point in each respiratory cycle, and calculates the thickening rate; and obtaining the average maximum thickness, the average minimum thickness and the average thickening rate of the fixed point positions in a plurality of respiratory cycles, and taking the obtained average thickening rate as the diaphragm thickening rate of the tested person. The formula for calculating the diaphragm muscle thickening rate is diaphragm muscle thickening rate = (end inspiration thickness-end expiration thickness)/end expiration thickness 100%.
Further preferably, the linear array probe is used for monitoring in the process of acquiring the ultrasonic image of the diaphragm thickening rate change.
As another implementation manner of this embodiment, in the step S2, the two ways of acquiring the ultrasound images of the change of the inferior vena cava state when the person being tested exhales and inhales include two, and one of the two kinds of acquiring may be acquired optionally, one is acquired through the xiphoid process, and the other is acquired through the posterior axillary line of the liver. Generally, when the lower section of the xiphoid process is difficult to obtain, such as prone position ventilation, the second obtaining mode is adopted for obtaining.
As shown in fig. 10, in the spontaneous breathing state, the IVC has a major/minor axis section, the inferior vena cava is collapsed for inspiration, and the end-inspiratory diameter is smaller than the end-expiratory diameter; in the complete mechanical ventilation state, the inferior vena cava inhales and expands, and the end-inspiratory diameter is larger than the end-expiratory diameter.
As shown in fig. 10, in the spontaneous respiration state, the ultrasound acquires the long-axis image of the inferior vena cava, wherein the distance 1 is the diameter of the inferior vena cava at the end of respiration, and the distance 2 is the diameter of the inferior vena cava at the end of inspiration.
As shown in fig. 11 and 12, in the spontaneous breathing state, the ultrasound acquires the minor axis image of the inferior vena cava, wherein fig. 11 is the minor axis image of the inferior vena cava at the end of inspiration, and fig. 12 is the minor axis image of the inferior vena cava at the end of expiration.
In the above embodiment, the AI identification tool integrates a machine learning model, which may be a traditional machine learning method, a deep learning method, or a Reverse Classification Accuracy method, and the like, wherein the detection method of deep learning includes a CNN model based on AlexNet, VGG, inclusion, ResNet, densinet, etc., or a multi-layer sensor composed of fully connected layers. The traditional machine learning method comprises a feature extraction method and a classification method, wherein the feature extraction method can be a CNN model or PCA, HOG, LDA and other traditional methods, and the classification method can be KNN, SVM, random forest and other methods.
For example, the present application does not specifically limit the implementation manner of the diaphragm motion parameter and the inferior vena cava state parameter in the S3 step.
In one embodiment, the ultrasound image to be identified may be image segmented to determine diaphragmatic muscle mobility, diaphragmatic muscle thickening rate, and inferior vena cava collapse or expansion in the ultrasound image. The method of image segmentation may be a segmentation method based on deep learning, or conventional machine learning. The deep learning detection method may be a CNN model based on FCN, U-Net, RCNN, YOLO, inclusion, ResNet, DenseNet, etc., or a multilayer sensor composed of full connection layers. Illustratively, the ultrasound image may be input to a CNN model acquisition output that includes diaphragm movement, diaphragm thickening rate, and inferior vena cava collapse or expansion. The traditional machine learning method comprises a feature extraction method and a classification method, wherein the feature extraction method can be a CNN model or traditional methods such as PCA, HOG and LDA, and the classification method can be a KNN, SVM and random forest method.
As another preferred embodiment of the present invention, this embodiment discloses an apparatus for respiratory drive assessment using ultrasound, the apparatus comprising:
the ultrasonic image acquisition module is used for establishing data transmission connection with the ultrasonic equipment and receiving a diaphragm state change ultrasonic image and an inferior vena cava state change ultrasonic image which are acquired by the ultrasonic equipment;
the AI identification module is used for identifying the ultrasonic image of the diaphragm muscle state change and the ultrasonic image of the inferior vena cava state change obtained by the ultrasonic image acquisition module; analyzing and processing the content of the ultrasonic image, measuring and calculating to obtain the diaphragm motion parameters and inferior vena cava state parameters of the tested person during expiration and inspiration;
and the respiratory drive evaluation and classification module is used for comparing the diaphragmatic motion parameter and the inferior vena cava state parameter obtained by combining the AI identification module with a diaphragmatic motion parameter setting threshold and an inferior vena cava state parameter setting threshold respectively, and evaluating and classifying the respiratory drive of the tested person according to the comparison result.
As an implementation manner of this embodiment, the apparatus further includes an early warning feedback module, and the early warning feedback module sends out early warning feedback information according to the evaluation and classification result of the respiration driving evaluation and classification module. The early warning feedback information can be correspondingly set according to the driving evaluation and classification results (such as the suggestion column in table 3 above), so that the early warning feedback information includes intervention suggestions, so that medical staff can perform intervention operations.
Claims (18)
1. A method for respiratory drive assessment using ultrasound, the method comprising the steps of:
s1, monitoring the diaphragm position of the tested person by using ultrasonic equipment, capturing the diaphragm motion state of the tested person during expiration and inspiration, and acquiring the diaphragm state change ultrasonic images during expiration and inspiration;
s2, monitoring the position of the inferior vena cava of the tested person by using ultrasonic equipment, capturing the motion state of the inferior vena cava of the tested person during expiration and inspiration, and acquiring the ultrasound image of the change of the inferior vena cava state during expiration and inspiration;
s3, identifying the diaphragm muscle state change ultrasonic image and the inferior vena cava state change ultrasonic image obtained in the steps S1 and S2 by using an AI identification tool; analyzing and processing the content of the ultrasonic image, measuring and calculating to obtain the diaphragm motion parameters and inferior vena cava state parameters of the tested person during expiration and inspiration;
and S4, comparing the diaphragm motion parameters and the inferior vena cava state parameters obtained in the step S3 with the diaphragm motion parameter setting threshold and the inferior vena cava state parameter setting threshold respectively, and evaluating and classifying the respiratory drive of the tested person according to the comparison result.
2. The method for breath-driven assessment using ultrasound according to claim 1, wherein: the diaphragm motion parameters comprise diaphragm movement degree; the inferior vena cava state parameters comprise inferior vena cava respiratory variability; the diaphragm motion parameter setting threshold comprises a diaphragm movement degree threshold; the inferior vena cava state parameter setting threshold comprises an inferior vena cava respiratory variability threshold.
3. The method for breath-driven assessment using ultrasound according to claim 2, wherein: the diaphragm movement parameters further comprise a diaphragm thickening rate, and the diaphragm movement parameter setting threshold further comprises a diaphragm thickening rate threshold.
4. The method for breath-driven assessment using ultrasound according to claim 2, wherein: the inferior vena cava respiratory variability comprises IVC collapse rate or IVC expansion rate;
the IVC collapse rate is calculated under the autonomous respiration mode of the tested person, and the calculation formula is
IVC collapse rate = (IVC end-inspiratory)/IVC end-expiratory 100%;
the IVC expansion rate is calculated under the condition that the tested person does not have the spontaneous respiration mode, and the calculation formula is
IVC expansion rate = (end IVC inspiration-end IVC expiration)/end IVC expiration 100%.
5. The method for breath-driven assessment using ultrasound according to claim 4, wherein: the inferior vena cava respiratory variability threshold comprises an IVC collapse rate threshold or an IVC expansion rate threshold.
6. The method for breath-driven assessment by ultrasound according to any of claims 1 to 5, wherein: in the step S1, the ultrasonic images of diaphragm state changes obtained when the person to be tested exhales and inhales include an ultrasonic image of diaphragm displacement changes and an ultrasonic image of diaphragm thickening rate changes.
7. The method for breath-driven assessment using ultrasound according to claim 6, wherein: specifically, the ultrasonic image of the diaphragm displacement change is obtained by using an ultrasonic probe, wherein a mark point of the ultrasonic probe faces to the inner side and slides to the lower part of the costal margin from the abdomen of the person to be tested to expose the diaphragm top; recording ultrasonic images of diaphragm displacement changes in at least 3 respiratory cycles in a B ultrasonic mode, and storing an kinegram; and then switches to M mode.
8. The method for breath-driven assessment using ultrasound according to claim 7, wherein: in the step of S3, the AI identification tool identifies the ultrasonic image of diaphragm displacement change and calculates the maximum displacement value of a certain fixed point position in each respiratory cycle; and obtaining the average displacement value of a plurality of respiratory cycles as the diaphragm movement degree of the tested person.
9. The method for respiratory drive assessment by ultrasound according to claim 7 or 8, characterized in that: and monitoring by using a convex array probe in the process of acquiring the diaphragm displacement change ultrasonic image.
10. The method for breath-driven assessment using ultrasound according to claim 6, wherein: the ultrasonic image of the change of the thickening rate of the diaphragm is obtained by sliding an ultrasonic probe from the abdomen to the chest along the axillary midline of a person to be tested, rotating the ultrasonic probe along the intercostal space at the position where the curtain sign appears, fully exposing the diaphragm, recording the ultrasonic image of the change of the thickness of the diaphragm in at least 3 respiratory cycles, and storing a motion picture; and switching to an M mode for calculation.
11. The method for breath-driven assessment using ultrasound according to claim 10, wherein: in the step of S3, the AI identification tool identifies the ultrasonic image of diaphragm thickness variation, calculates the maximum thickness and the minimum thickness of a certain fixed point in each respiratory cycle, and calculates the thickening rate; and obtaining the average maximum thickness, the average minimum thickness and the average thickening rate of the fixed point positions in a plurality of respiratory cycles, and taking the obtained average thickening rate as the diaphragm thickening rate of the tested person.
12. The method for breath-actuated assessment using ultrasound according to claim 11, wherein: the calculation formula of the diaphragm muscle thickening rate is
Diaphragm muscle thickening rate = (end inspiratory thickness-end expiratory thickness)/end expiratory thickness 100%.
13. A method for breath-actuated assessment by ultrasound according to any of claims 10 to 12, wherein: and monitoring by using a linear array probe in the process of acquiring the ultrasonic image of the diaphragm thickening rate change.
14. The method of breath-actuated assessment by ultrasound according to any of claims 1 to 5, wherein: in the step S2, the two ways of acquiring the ultrasound image of the change of the inferior vena cava state when the person to be tested exhales and inhales include two, one of the two ways of acquiring may be optionally acquired, one is acquired under the xiphoid process, and the other is acquired through the posterior axillary line of the liver.
15. The method for breath-actuated assessment using ultrasound according to claim 14, wherein: the inferior vena cava ultrasound image can be obtained by means of the subxiphoid process, two section images of the inferior vena cava can be displayed, namely a long-axis section of the inferior vena cava and a short-axis section of the inferior vena cava, and one of the two section images can be selected to be obtained when the ultrasound image of the state change of the inferior vena cava is obtained.
16. The method of breath-actuated assessment by ultrasound according to any of claims 1 to 5, wherein: according to the comparison result, the respiratory drive evaluation and classification of the tested person specifically means,
the method comprises the steps that the diaphragm movement degree of a mechanical ventilator in a spontaneous respiration mode is larger than a diaphragm movement degree threshold, the diaphragm thickening rate is larger than a diaphragm thickening rate threshold, and meanwhile, if the IVC state is inspiration collapse, the mechanical ventilator is evaluated to be high-drive spontaneous respiration;
the diaphragmatic muscle mobility of the mechanical ventilator in the spontaneous breathing mode is larger than a diaphragmatic muscle mobility threshold, the diaphragm thickening rate is smaller than a diaphragm thickening rate threshold, and meanwhile, if the IVC state is inspiration collapse, the evaluation is that the spontaneous breathing is high-driven;
the diaphragmatic muscle mobility of a mechanical ventilator without spontaneous respiration is larger than a diaphragmatic muscle mobility threshold, the diaphragm thickening rate is smaller than a diaphragm thickening rate threshold, and meanwhile, if the IVC state is inspiration expansion, the ventilator ventilation parameter is evaluated to be set too high;
and (3) no mechanical ventilator exists in the complete spontaneous breathing mode, the diaphragm movement degree is greater than a diaphragm movement degree threshold, the diaphragm thickening rate is greater than a diaphragm thickening rate threshold, and meanwhile, if the IVC state is inspiration collapse, the autonomous breathing high-driving is evaluated.
17. Apparatus for breath-driven assessment using ultrasound, the apparatus comprising:
the ultrasonic image acquisition module is used for establishing data transmission connection with the ultrasonic equipment and receiving a diaphragm state change ultrasonic image and an inferior vena cava state change ultrasonic image which are acquired by the ultrasonic equipment;
the AI identification module is used for identifying the ultrasonic image of the diaphragm muscle state change and the ultrasonic image of the inferior vena cava state change obtained by the ultrasonic image acquisition module; analyzing and processing the content of the ultrasonic image, measuring and calculating to obtain the diaphragm motion parameters and inferior vena cava state parameters of the tested person during expiration and inspiration;
and the respiratory drive evaluation and classification module is used for comparing the diaphragm motion parameter and the inferior vena cava state parameter obtained by combining the AI identification module with a diaphragm motion parameter setting threshold and an inferior vena cava state parameter setting threshold respectively, and evaluating and classifying the respiratory drive of the tested personnel according to the comparison result.
18. The apparatus for breath-actuated evaluation using ultrasound according to claim 17, wherein: the device also comprises an early warning feedback module which sends out early warning feedback information according to the evaluation and classification results of the respiratory drive evaluation and classification module.
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