摘要
目的比较俯卧位联合无创通气对轻中度急性呼吸窘迫综合征(acute respiratory distress syndrome,ARDS)患者肺内局部气体分布和机械能的影响。方法纳入2018年1月—2020年1月河南省人民医院RICU收治的52例轻中度的ARDS患者,均采用电阻抗断层成像技术(electrical impedance tomography,EIT)技术监测感兴趣区域(regions of interest,ROI)值,按照随机数字法将52例ARDS患者随机分为观察组和对照组,其中,对照组采用平卧位无创通气,观察组患者取俯卧位无创通气。观察两组在体位变化12 h和24 h的动脉血气分析、不同分区通气分布和机械能的差异。结果两组患者治疗后12 h和24 h两个时间点血气分析指标比较,与对照组相比,治疗后12 h观察组患者氧合指数升高且差异有统计学意义(141.54±7.93 vs 135.47±8.69,P=0.003);治疗后24 h观察组患者治疗后PaO_(2)[(64.83±2.08)mmHg vs(62.45±2.26)mmHg,P=0.002]和氧合指数(159.84±11.14 vs 139.46±12.91,P=0.001)升高且差异有统计学意义;PaCO_(2)均显著下降且差异有统计学意义[(44.67±2.49)mmHg vs(49.73±2.74)mmHg,P<0.001;(41.81±2.98)mmHg vs(48.15±2.87)mmHg,P<0.001]。与对照组相比,治疗后12 h和24 h观察组患者依赖区潮气量比例明显升高,差异有统计学意义(5.66±0.30 vs 3.64±0.73,P<0.001;7.89±0.74 vs 4.95±0.14,P<0.001);与对照组相比,治疗后12 h和24 h观察组患者总机械能和依赖区机械能明显下降,差异有统计学意义(P<0.05)。结论对于早期轻中度ARDS患者行俯卧位无创通气治疗,能够有效改善呼吸窘迫和氧合情况,增加重力依赖区通气,降低重力依赖区的局部机械能。
Objective To compare the effects of prone position combined with non-invasive ventilation on local gas distribution and mechanical energy in the lungs of patients with mild to moderate acute respiratory distress syndrome(ARDS).Methods A total of 52 patients with mild to moderate ARDS admitted to the RICU of Henan Provincial People's Hospital from January 2018 to January 2020 were included in this study.All patients were monitored using electrical impedance tomography(EIT)to measure the values of regions of interest(ROI).They were randomly divided into an observation group and a control group using a random number method.The control group received supine non-invasive ventilation,while the observation group received prone non-invasive ventilation.Arterial blood gas analysis,ventilation distribution in different lung regions,and mechanical energy were compared between the two groups at 12 and 24 hours after the change in position.Results At 12 and 24 hours after treatment,the arterial blood gas analysis indicators showed significant differences between the two groups.Compared with the control group,the oxygenation index in the observation group was significantly higher at 12 hours after treatment(141.54±7.93 vs 135.47±8.69,P=0.003).At 24 hours after treatment,the PaO_(2) and oxygenation index in the observation group were significantly higher[(64.83±2.08)mmHg vs(62.45±2.26)mmHg,P=0.002;(159.84±11.14)vs(139.46±12.91),P<0.001],and PaCO_(2) was significantly lower[(44.67±2.49)mmHg vs(49.73±2.74)mmHg,P<0.001;(41.81±2.98)mmHg vs(48.15±2.87)mmHg,P<0.001].The tidal volume proportion in the dependent lung regions was significantly higher in the observation group at both 12 and 24 hours after treatment compared with the control group(5.66±0.30 vs 3.64±0.73,P<0.001;7.89±0.74 vs 4.95±0.14,P<0.001).The total mechanical energy and mechanical energy in the dependent lung regions were significantly lower in the observation group at both 12 and 24 hours after treatment compared with the control group(P<0.05).Conclusion Prone position non-invasive ventilation is effective in improving respiratory distress and oxygenation in patients with early mild to moderate ARDS.It increases ventilation in the gravity-dependent lung regions and reduces local mechanical energy in these areas.
作者
李静
高胜浩
李香雪
LI Jing;GAO Sheng-hao;LI Xiang-xue(Department of Operating Room,the First Affiliated Hospital of Zhengzhou University,Zhengzhou 450000,China;Department of Respiratory and Critical Care Medicine,Henan Provincial Peoples Hospital,Peoples Hospital of Zhengzhou University,Zhengzhou 450003,China;Department of Neurosurgery,the First Affiliated Hospital of Zhengzhou University,Zhengzhou 450000,China)
出处
《医药论坛杂志》
2025年第10期1100-1103,共4页
Journal of Medical Forum
关键词
俯卧位通气
急性呼吸窘迫综合征
机械能
电阻抗成像技术
Prone position ventilation
Acute respiratory distress syndrome
Mechanical energy
Electrical impedance imaging technology
