本文關(guān)鍵詞： 肺部超聲 最大氧合法 急性呼吸窘迫綜合征 肺復(fù)張 超聲再氣化評(píng)分　出處：《中國(guó)呼吸與危重監(jiān)護(hù)雜志》2017年06期 　論文類(lèi)型：期刊論文

【摘要】：目的 評(píng)價(jià)床旁肺部超聲在急性呼吸窘迫綜合征(acute respiratory distress syndrome,ARDS)患者肺復(fù)張治療中的應(yīng)用價(jià)值。方法 選擇入住江西省人民醫(yī)院重癥醫(yī)學(xué)科的60例ARDS患者,隨機(jī)分為最大氧合法組(n=30)和肺部超聲法組(n=30),兩組患者均建立人工氣道進(jìn)行機(jī)械通氣。兩組患者進(jìn)行肺復(fù)張過(guò)程中分別以最大氧合法和肺部超聲法來(lái)滴定最佳呼氣末正壓(positive end-expiratory pressure,PEEP),記錄兩組患者肺復(fù)張前后的動(dòng)脈血氧分壓(arterial partial pressure of oxygen,PaO_2)、PEEP水平、中心靜脈壓(central venous pressure,CVP)、平均動(dòng)脈壓(mean arterial pressure,MAP)、心排出量(cardiac output,CO)、血管外肺水指數(shù)(extravascular lung water index,EVLWI)以及兩組不良事件的發(fā)生情況。結(jié)果 肺部超聲組在肺復(fù)張末時(shí)PaO_2高于最大氧合法組(P=0.04),復(fù)張末的PEEP值也略高,但差異無(wú)統(tǒng)計(jì)學(xué)意義(P=0.910)。兩組患者肺復(fù)張末的CVP、MAP、CO、EVLWI等血流動(dòng)力學(xué)指標(biāo)比較,差異均無(wú)統(tǒng)計(jì)學(xué)意義(P均0.05)。結(jié)論 床旁肺部超聲可以有效地指導(dǎo)ARDS患者的肺復(fù)張過(guò)程,是一種無(wú)創(chuàng)、可重復(fù)性好、安全經(jīng)濟(jì)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.
【作者單位】： 江西省人民醫(yī)院重癥醫(yī)學(xué)科;
【基金】：江西省衛(wèi)生計(jì)生委2015年科技計(jì)劃(20151002)
【分類(lèi)號(hào)】：R563.8

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