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.
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 untra-sound diagnostic system.The diaphragm data were recorded during calm breathing and deep breathing,includ-ing 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 in-tra-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 mo-bility during calm breathing,diaphragm muscle mobility during deep breathing,diaphragmatic thickness during calm exhalation,diaphragmatic thickness during calm inspiration,diaphragmatic thickness during maximal exha-lation 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 in-ter-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 analy-sis showed no systematic errors. Conclusion:Ultrasound has good reliability in diaphragm function evaluation and can provide objective evi-dence in clinical application.