【摘要】：目的利用電阻抗斷層成像技術(shù)(electrical impedance tomography,EIT)觀測(cè)急性呼吸窘迫綜合征(acute respiratory distress syndrome,ARDS)患者機(jī)械通氣時(shí),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(jī)對(duì)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(hù)病房2015年1月至2017年6月收治行機(jī)械通氣的ARDS患者作為研究對(duì)象,應(yīng)用隨機(jī)數(shù)字表法分為試驗(yàn)組和對(duì)照組。試驗(yàn)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(duì)照組設(shè)定為體位持續(xù)抬高30°。比較2組患者入組時(shí)、體位有效保持72、96、120 h后,分別通過(guò)EIT收集2組患者的感興趣區(qū)域(region of interest,ROI)值,同時(shí)收集患者潮氣量、通過(guò)血?dú)夥治鍪占醴謮骸⒀鹾现笖?shù)等參數(shù),以及呼吸機(jī)使用時(shí)間和監(jiān)護(hù)室住院時(shí)間。結(jié)果研究期間最終共60例患者納入分析,其中試驗(yàn)組27例,對(duì)照組33例。2組患者性別、年齡、急性生理和慢性健康評(píng)分Ⅱ(acute physiology and chronic health evaluationⅡ,APACHEⅡ)評(píng)分以及導(dǎo)致ARDS的病因等比較差異無(wú)統(tǒng)計(jì)學(xué)意義。與對(duì)照組相比,試驗(yàn)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(duì)照組,2組比較差異均有統(tǒng)計(jì)學(xué)意義(P0.05),同時(shí)通過(guò)EIT觀測(cè)試驗(yàn)組患者肺重力依賴(lài)區(qū)96 h及120 h ROI3值、ROI4值明顯高于對(duì)照組,差異均有統(tǒng)計(jì)學(xué)意義(P0.05),試驗(yàn)組患者呼吸機(jī)使用時(shí)間及監(jiān)護(hù)室住院時(shí)間明顯低于對(duì)照組,差異有統(tǒng)計(jì)學(xué)意義(P0.05),試驗(yàn)組與對(duì)照組患者在體位有效保持96 h及120 h后潮氣量值差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05),試驗(yàn)組與對(duì)照組患者體位有效保持72 h時(shí)比較,氧分壓、氧合指數(shù)、潮氣量差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)。結(jié)論對(duì)于ARDS患者行機(jī)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(lài)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(jìn)患者早日成功脫機(jī)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(hào)：2336135