肺部超声在急性呼吸窘迫综合征患者肺复张治疗中的应用

发布时间：2018-02-26 14:14

本文关键词： 肺部超声最大氧合法急性呼吸窘迫综合征肺复张超声再气化评分　出处：《中国呼吸与危重监护杂志》2017年06期 　论文类型：期刊论文

【摘要】：目的评价床旁肺部超声在急性呼吸窘迫综合征(acute respiratory distress syndrome,ARDS)患者肺复张治疗中的应用价值。方法选择入住江西省人民医院重症医学科的60例ARDS患者,随机分为最大氧合法组(n=30)和肺部超声法组(n=30),两组患者均建立人工气道进行机械通气。两组患者进行肺复张过程中分别以最大氧合法和肺部超声法来滴定最佳呼气末正压(positive end-expiratory pressure,PEEP),记录两组患者肺复张前后的动脉血氧分压(arterial partial pressure of oxygen,PaO_2)、PEEP水平、中心静脉压(central venous pressure,CVP)、平均动脉压(mean arterial pressure,MAP)、心排出量(cardiac output,CO)、血管外肺水指数(extravascular lung water index,EVLWI)以及两组不良事件的发生情况。结果肺部超声组在肺复张末时PaO_2高于最大氧合法组(P=0.04),复张末的PEEP值也略高,但差异无统计学意义(P=0.910)。两组患者肺复张末的CVP、MAP、CO、EVLWI等血流动力学指标比较,差异均无统计学意义(P均0.05)。结论床旁肺部超声可以有效地指导ARDS患者的肺复张过程,是一种无创、可重复性好、安全经济的方法。
[Abstract]:Objective to evaluate the clinical value of bedside pulmonary ultrasound in the treatment of acute respiratory distress syndrome (ARDS) patients with acute respiratory distress syndrome (ARDS). Methods 60 cases of ARDS patients admitted to the Department of intensive Medicine of Jiangxi Provincial people's Hospital were selected. The two groups were randomly divided into two groups: the maximal oxygen group (n = 30) and the pulmonary ultrasound group (n = 30). Both groups of patients established artificial airway for mechanical ventilation. The maximal oxygen method and the lung ultrasound method were used to titrate the best breath in the two groups during the process of lung reopening. Positive end-expiratory pressure (PEEPV) was used to record the arterial partial pressure of oxygenation Pa2P before and after pulmonary resuscitation in the two groups, and to record the peep level in the two groups before and after pulmonary resuscitation. Central venous pressure, mean arterial pressure MAPP, cardiac output, extravascular lung water indexEVLWIs, and the occurrence of adverse events in the pulmonary ultrasound group were higher than those in the maximal oxygenation group at the end of pulmonary reopening. The PEEP value at the end of retensionis also slightly higher. But there was no significant difference between the two groups (P < 0. 910). There was no significant difference in hemodynamic indexes such as CVP MAPMAPCOE VLWI between the two groups. Conclusion Pulmonary ultrasound beside the bed can effectively guide the process of pulmonary reexpansion in patients with ARDS, and it is a noninvasive one. Reproducible, safe and economical method.
【作者单位】：江西省人民医院重症医学科;
【基金】：江西省卫生计生委2015年科技计划(20151002)
【分类号】：R563.8

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