摘要
目的探讨功能残气量(FRC)与肺部超声评分(LUS)监测俯卧位对急性呼吸窘迫综合征(ARDS)患者最佳呼气末正压(PEEP)以及局部通气效果的影响.方法选择2018年10月至2019年12月锦州医科大学附属第一医院行有创通气治疗的70例中重度ARDS患者作为研究对象,记录患者接受俯卧位通气治疗2、16、48 h的FRC、LUS评分和最佳PEEP值,分析各时间点FRC与LUS评分的相关性,并观察氧合指数(OI)、静态顺应性(Cst)、机械能(MP)的变化趋势.结果共53例患者纳入本研究,其中36例存活,17例死亡.随俯卧位通气时间延长,存活患者FRC呈明显上升趋势,死亡患者呈先降低后升高趋势,且以存活组俯卧位通气48 h较死亡组升高最为明显(L:1.07±0.10比0.70±0.09,P<0.05);存活患者LUS评分呈明显下降趋势,死亡患者呈明显上升趋势,且以存活组俯卧位通气48 h较死亡组降低最为明显(分:16.08±2.75比20.88±2.58,P<0.05).存活组俯卧位通气治疗各时间点最佳PEEP均明显低于同期死亡组〔cmH_(2)O(1 cmH_(2)O≈0.098 kPa):2 h为14.61±1.78比16.13±1.26,16 h为13.44±1.78比15.75±1.24,48 h为11.92±1.27比15.38±1.15,均P<0.05〕.Pearson相关分析显示,俯卧位通气治疗2、16、48 h FRC与LUS评分均存在显著相关性(r值分别为0.410、0.520、0.740,均P<0.05).随俯卧位通气时间延长,两组OI、Cst均呈逐渐升高趋势,以存活组俯卧位通气48 h较死亡组升高最为明显〔OI(mmHg,1 mmHg≈0.133 kPa):238.86±6.49比216.94±12.91,Cst(mL/cmH_(2)O):28.64±3.55比22.70±4.44,均P<0.05〕;存活组MP呈下降趋势,死亡组MP呈升高趋势,以存活组俯卧位通气48 h较死亡组降低最为明显(J/min:15.67±2.32比20.29±1.79,P<0.05).结论FRC和LUS评分有良好的相关性,可作为ARDS患者俯卧位通气过程中的监测指标,值得进一步推广和应用.
Objective To investigate using functional residual capacity(FRC)and lung ultrasound score(LUS)monitoring respiratory mechanical ventilation indexes such as optimal positive end-expiratory pressure(PEEP)and influencing local ventilation effect in patients with acute respiratory disease syndrome(ARDS)receiving prone position ventilation.Methods Seventy patients with moderate and severe ARDS treated by the invasive ventilation in the First Affiliated Hospital of Jinzhou Medical University from October 2018 to December 2019 were selected as the research objects.The FRC,LUS score and optimal PEEP value at 2 hours,16 hours and 48 hours in patients receiving prone ventilation treatment were recorded,the correlation between FRC and LUS score at each time point was analyzed and the changing trends of oxygenation index(OI),static compliance(Cst)and mechanical power(MP)were observed.Results A total of 53 patients were enrolled in this study,of which 36 survived and 17 died.With the prolongation of prone ventilation time,the FRC of survival patients showed a significant upward trend,while the FRC of the patients with death outcome firstly decreased and then increased,and the most obvious increase was at 48 hours in the survival group(L:1.07±0.10 vs.0.70±0.09,P<0.05).The LUS score of the survival patients showed a significant downward trend,while the patients with death outcome showed a significant upward trend,and the most obvious decrease was at 48 hours in the survival group under prone ventilation(16.08±2.75 vs.20.88±2.58,P<0.05).The optimal PEEP of the survival patients under prone ventilation therapy was significantly lower than that of the patients with death outcome at each same time point[cmH_(2)O(1 cmH_(2)O≈0.098 kPa):14.61±1.78 vs 16.13±1.26 at 2 hours,13.44±1.78 vs 15.75±1.24 at 16 hours,11.92±1.27 vs 15.38±1.15 at 48 hours,all P<0.05].Pearson correlation analysis showed that there were significant correlations between FRC and LUS score at 2 hours,16 hours and 48 hours after prone position ventilation(r values were 0.410,0.520 and 0.740,respectively,all P<0.05).With the prolongation of prone ventilation time,OI and Cst in both groups showed a gradually increasing trend,and the increase was the most significant in the survival group at 48 hours in prone ventilation:[OI(mmHg,1 mmHg≈0.133 kPa)238.86±6.49 vs.216.94±12.91,Cst(mL/cmH_(2)O):28.64±3.55 vs.22.70±4.44,both P<0.05];MP in the survival group showed a downward trend,while MP in the death group showed an upward trend,and the most obvious decrease in the survival group was at 48 hours after prone ventilation(J/min:15.67±2.32 vs.20.29±1.79,P<0.05).Conclusion FRC is well correlated with LUS score and these two indicators can be used for monitoring ARDS patients during prone position ventilation,being worthy to promote further extensive application.
作者
金永浩
李晓东
李甜
胡占升
邸兴伟
Jin Yonghao;Li Xiaodong;Li Tian;Hu Zhansheng;Di Xingwei(Department of Critical Care Medicine,the First Affiliated Hospital of Jinzhou Medical University,Jinzhou 121000,Liaoning,China;Department of Respiratory,the Third Affiliated Hospital of Jinzhou Medical University,Jinzhou 121000,Liaoning,China)
出处
《中国中西医结合急救杂志》
CAS
CSCD
北大核心
2021年第3期329-333,共5页
Chinese Journal of Integrated Traditional and Western Medicine in Intensive and Critical Care
基金
辽宁省科学技术计划项目(2020020112-JH2/101)
辽宁省重点研发计划(2020JH2/10100017)。
关键词
功能残气量
肺部超声评分
急性呼吸窘迫综合征
俯卧位
Functional residual capacity
Lung ultrasound score
Acute respiratory distress syndrome
Prone position
