超声在膈肌功能评估中的信度研究

关键词：超声  膈肌  信度

Keywords:ultrasound  diaphragm  the reliability

摘要：

      摘要 目的：分析超声用于膈肌功能评估的一致性及可重复性。 方法：采用PA12A型便携式彩色多普勒超声诊断系统。记录60例健康受试者平静呼吸和深呼吸时的膈肌数据，包括平静呼吸和深呼吸时的膈肌移动度、平静呼气和平静吸气时的膈肌厚度、最大呼气和最大吸气时的膈肌厚度，对以上指标的测试内信度、测试者间信度和重测信度分别进行分析。 结果：测试内信度：平静呼吸时膈肌移动度、深呼吸时膈肌移动度、平静呼气时膈肌厚度、平静吸气时膈肌厚度、最大呼气时膈肌厚度和最大吸气时膈肌厚度的组内相关系数（intra-class correlation coefficient， ICC）值分别为0.99、0.99、0.99、0.99、0.99、0.99；测试者间信度方面6个指标的ICC值分别为0.84、0.80、0.82、0.82、0.83、0.77；重测信度：6个指标的相对信度ICC值分别为0.98、0.86、0.98、0.97、0.94、0.86；绝对信度6个指标的测量标准误（standard error of measurement， SEM）分别为0.09、0.39、0.01、0.02、0.02、0.03，SEM%分别为5.23%、8.40%、5.38%、5.7%、8.17%、8.77%，最小真正改变量（minimal detectable change， MDC）分别为0.26、1.08、0.03、0.04、0.04、0.09，MDC%分别为14.48%、23.28%、14.9%、15.8%、22.64%、24.31%；Bland-Altman 图形分析显示无系统性误差。 结论：超声在膈肌功能评估中具有良好信度。

Abstract:

      Abstract Objective： To analyze the consistency and repeatability of ultrasonography in diaphragm function evaluation. Method： Sixty healthy subjects participated in the present study, using a PA12A portable color doppler untrasound diagnostic system. The diaphragm data were recorded during calm breathing and deep breathing， including diaphragm muscle mobility during calm breathing and deep breathing， diaphragmatic thickness during calm exhalation and calm inspiration，and diaphragmatic thickness during deep exhalation and deep inspiration. The intra-test reliability， inter-tester reliability and retest reliability of the above indexes were analyzed respectively. Result： For intra-test reliability， the intra-class correlation coefficient （ICC） values for diaphragm muscle mobility during calm breathing， diaphragm muscle mobility during deep breathing， diaphragmatic thickness during calm exhalation， diaphragmatic thickness during calm inspiration， diaphragmatic thickness during maximal exhalation and diaphragmatic thickness during maximal inspiration were 0.99， 0.99， 0.99， 0.99， 0.99， 0.99 and 0.99， respectively. The ICC values for the six indicators were 0.84， 0.80， 0.82， 0.82， 0.83， and 0.77 for inter-tester reliability. For retest reliability， the ICC values for the six indicators were 0.98， 0.86， 0.98， 0.97， 0.94， and 0.86 for relative reliability. The standard error of measurement （SEM） for the absolute reliability of the six indicators were 0.09， 0.39， 0.01， 0.02， 0.02， 0.03， SEM% were 5.23%， 8.40%， 5.38%， 5.7%， 8.17%， 8.77%， and the minimal detectable change （MDC） were 0.25， 1.08， 0.03， 0.04， 0.04， 0.09， and MDC% were 14.49%， 23.28%， 14.9%， 15.8%， 22.64%， 24.31%， respectively. Bland-Altman graphical analysis showed no systematic errors. Conclusion： Ultrasound has good reliability in diaphragm function evaluation and can provide objective evidence in clinical application.