【摘要】：目的利用電阻抗斷層成像技術(shù)(electrical impedance tomography,EIT)觀測急性呼吸窘迫綜合征(acute respiratory distress syndrome,ARDS)患者機械通氣時,在不同體位下患者的肺內(nèi)氣體分布情況,并觀察氧分壓、氧合指數(shù)、潮氣量的變化情況。方法采用前瞻性隨機對照研究方法,選擇首都醫(yī)科大學(xué)附屬北京潞河醫(yī)院急診重癥監(jiān)護病房2015年1月至2017年6月收治行機械通氣的ARDS患者作為研究對象,應(yīng)用隨機數(shù)字表法分為試驗組和對照組。試驗組設(shè)定為常規(guī)體位有效抬高30°的基礎(chǔ)上,每日間斷予患者采取90°端坐位8 h;對照組設(shè)定為體位持續(xù)抬高30°。比較2組患者入組時、體位有效保持72、96、120 h后,分別通過EIT收集2組患者的感興趣區(qū)域(region of interest,ROI)值,同時收集患者潮氣量、通過血氣分析收集氧分壓、氧合指數(shù)等參數(shù),以及呼吸機使用時間和監(jiān)護室住院時間。結(jié)果研究期間最終共60例患者納入分析,其中試驗組27例,對照組33例。2組患者性別、年齡、急性生理和慢性健康評分Ⅱ(acute physiology and chronic health evaluationⅡ,APACHEⅡ)評分以及導(dǎo)致ARDS的病因等比較差異無統(tǒng)計學(xué)意義。與對照組相比,試驗組患者在體位有效保持96 h及120 h后Pa O2及氧合指數(shù)明顯高于對照組,2組比較差異均有統(tǒng)計學(xué)意義(P0.05),同時通過EIT觀測試驗組患者肺重力依賴區(qū)96 h及120 h ROI3值、ROI4值明顯高于對照組,差異均有統(tǒng)計學(xué)意義(P0.05),試驗組患者呼吸機使用時間及監(jiān)護室住院時間明顯低于對照組,差異有統(tǒng)計學(xué)意義(P0.05),試驗組與對照組患者在體位有效保持96 h及120 h后潮氣量值差異無統(tǒng)計學(xué)意義(P0.05),試驗組與對照組患者體位有效保持72 h時比較,氧分壓、氧合指數(shù)、潮氣量差異無統(tǒng)計學(xué)意義(P0.05)。結(jié)論對于ARDS患者行機械通氣期間,每日間斷予患者采取90°端坐位8 h以上,在96 h后,能夠有效改善重力依賴區(qū)的肺通氣情況,有效改善患者的氧分壓及氧合指數(shù),促進患者早日成功脫機拔管。
[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 擄by routine posture, the patients in the test group were given 90 擄sitting position for 8 h intermittently, while the control group was set as the continuous elevation of 30 擄. 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，

本文編號：2336135