通过电阻抗断层成像技术观察体位对机械通气ARDS患者肺通气的影响
发布时间：2018-11-16 17:20
【摘要】：目的利用电阻抗断层成像技术(electrical impedance tomography,EIT)观测急性呼吸窘迫综合征(acute respiratory distress syndrome,ARDS)患者机械通气时,在不同体位下患者的肺内气体分布情况,并观察氧分压、氧合指数、潮气量的变化情况。方法采用前瞻性随机对照研究方法,选择首都医科大学附属北京潞河医院急诊重症监护病房2015年1月至2017年6月收治行机械通气的ARDS患者作为研究对象,应用随机数字表法分为试验组和对照组。试验组设定为常规体位有效抬高30°的基础上,每日间断予患者采取90°端坐位8 h;对照组设定为体位持续抬高30°。比较2组患者入组时、体位有效保持72、96、120 h后,分别通过EIT收集2组患者的感兴趣区域(region of interest,ROI)值,同时收集患者潮气量、通过血气分析收集氧分压、氧合指数等参数,以及呼吸机使用时间和监护室住院时间。结果研究期间最终共60例患者纳入分析,其中试验组27例,对照组33例。2组患者性别、年龄、急性生理和慢性健康评分Ⅱ(acute physiology and chronic health evaluationⅡ,APACHEⅡ)评分以及导致ARDS的病因等比较差异无统计学意义。与对照组相比,试验组患者在体位有效保持96 h及120 h后Pa O2及氧合指数明显高于对照组,2组比较差异均有统计学意义(P0.05),同时通过EIT观测试验组患者肺重力依赖区96 h及120 h ROI3值、ROI4值明显高于对照组,差异均有统计学意义(P0.05),试验组患者呼吸机使用时间及监护室住院时间明显低于对照组,差异有统计学意义(P0.05),试验组与对照组患者在体位有效保持96 h及120 h后潮气量值差异无统计学意义(P0.05),试验组与对照组患者体位有效保持72 h时比较,氧分压、氧合指数、潮气量差异无统计学意义(P0.05)。结论对于ARDS患者行机械通气期间,每日间断予患者采取90°端坐位8 h以上,在96 h后,能够有效改善重力依赖区的肺通气情况,有效改善患者的氧分压及氧合指数,促进患者早日成功脱机拔管。
[Abstract]:Objective to observe the distribution of lung gas in patients with acute respiratory distress syndrome (acute respiratory distress syndrome,ARDS) during mechanical ventilation with electrical impedance tomography (electrical impedance tomography,EIT), and to observe the partial pressure of oxygen and oxygenation index. A change in the volume of moisture. Methods A prospective randomized controlled study was conducted in the emergency intensive care unit (EICU) of Beijing Luhe Hospital affiliated to Capital Medical University from January 2015 to June 2017. The method of random digital table was used to divide the experimental group and control group. On the basis of effective elevation of 30 掳by routine posture, the patients in the test group were given 90 掳sitting position for 8 h intermittently, while the control group was set as the continuous elevation of 30 掳. The (region of interest,ROI values of the region of interest of the two groups were collected by EIT, the tidal volume was collected at the same time, and the partial pressure of oxygen and oxygen index were collected by blood gas analysis. Time of use of ventilator and hospitalization time of intensive care unit. Results A total of 60 patients were included in the study, including 27 patients in the trial group and 33 patients in the control group. Sex, age, acute physiological and chronic health score 鈪，
本文编号：2336135
[Abstract]:Objective to observe the distribution of lung gas in patients with acute respiratory distress syndrome (acute respiratory distress syndrome,ARDS) during mechanical ventilation with electrical impedance tomography (electrical impedance tomography,EIT), and to observe the partial pressure of oxygen and oxygenation index. A change in the volume of moisture. Methods A prospective randomized controlled study was conducted in the emergency intensive care unit (EICU) of Beijing Luhe Hospital affiliated to Capital Medical University from January 2015 to June 2017. The method of random digital table was used to divide the experimental group and control group. On the basis of effective elevation of 30 掳by routine posture, the patients in the test group were given 90 掳sitting position for 8 h intermittently, while the control group was set as the continuous elevation of 30 掳. The (region of interest,ROI values of the region of interest of the two groups were collected by EIT, the tidal volume was collected at the same time, and the partial pressure of oxygen and oxygen index were collected by blood gas analysis. Time of use of ventilator and hospitalization time of intensive care unit. Results A total of 60 patients were included in the study, including 27 patients in the trial group and 33 patients in the control group. Sex, age, acute physiological and chronic health score 鈪，
本文编号：2336135
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