振动反应成像技术在ARDS患者PEEP设置中的应用  

Effects of vibration response imaging on positive end-expiratory pressure setting in patients with acute respiratory distress syndrome

作　　者：王丽[1] 宋宁宁[2] 刘云[1] 谭焰[1] Wang Li;Song Ningning;Liu Yun;Tan Yan(Department of Respiratory and Critical Care Medicine, Nanjing First Hospital, Nanjing Medical University, Nanjing 210006, China;Equipment Section, Nanjing First Hospital, Nanjing Medical University, Nanjing 210006, China)

机构地区：[1]南京医科大学附属南京医院(南京市第一医院)呼吸与危重症医学科,210006 [2]南京医科大学附属南京医院(南京市第一医院)设备科,210006

出　　处：《国际呼吸杂志》2019年第3期210-214,共5页International Journal of Respiration

基　　金：南京市卫生局科技发展重点项目(ZKX15025).

摘　　要：目的探讨振动反应成像技术(VRI)在急性呼吸窘迫综合征(ARDS)患者呼气末正压(PEEP)设置中的作用和临床疗效观察。方法30例ARDS患者在肺复张后,以随机数字表法随机采用ARDSnet法、最佳顺应性法和VRI法设置PEEP。比较3组患者在治疗0、24、48、72h呼吸力学、血流动力学和血管外肺水的变化。结果PEEPCst为(12.6±2.7)cmH2O(1cmH2O=0.098kPa),PEEPVRI为(13.0±2.5)cmH2O,两者差异无统计学意义,但明显高于PEEPARDSnet[(9.6±2.1)cmH2O,P<0.05]。治疗72h后,ARDSnet组肺顺应性无明显变化,VRI组和最佳顺应性组在24h后逐渐增高,且明显高于ARDSnet组。3组治疗后氧合指数均显著升高,且VRI组显著高于ARDSnet组(P<0.05)。治疗前后3组心率、中心静脉压、平均动脉压和心指数无明显改变。血管外肺水指数和肺血管通透性指数在72h均显著降低,最佳顺应性组和VRI组的血管外肺水指数较ARDSnet组降低更明显。结论VRI法设置的PEEP可以提高ARDS患者肺顺应性,改善氧合,降低血管外肺水,且对血流动力学无不良影响。Objective To explore the feasibility of vibration response imaging (VRI) on positive end-expiratory pressure (PEEP) in patients with acute respiratory distress syndrome (ARDS). Methods Total thirty patients with ARDS were studied.PEEP was randomly assigned to the ARDSnet method, the best compliance method, and the VRI method after lung recruitment.The changes of respiratory mechanics, hemodynamics and extravascular lung water were compared among the three groups at 0 h, 24 h, 48 h and 72 h. Results PEEPCst was (12.6±2.7) cmH2O (1 cmH2O=0.098 kPa), and PEEPVRI was (13.0±2.5) cmH2O.There was no significant difference between them, but they were significantly higher than PEEPARDSnet [(9.6±2.1) cmH2O, P<0.05]. There was no significant change in lung compliance in the ARDSnet group after 72 hours of treatment.The lung compliance of VRI group and the best compliance group gradually increased after 24 hours, and was significantly higher than that of the ARDSnet group.The oxygenation index of the three groups was significantly increased after treatment, and the oxygenation index of the VRI group was significantly higher than that of the ARDSnet group (P<0.05). There were no significant changes in heart rate, central venous pressure, mean arterial pressure, and cardiac index among the three groups before and after treatment.Extravascular lung water index and pulmonary vascular permeability index were significantly lower at 72 h, and extravascular lung water index in the best compliance group and VRI group was significantly lower than that in the ARDSnet group. Conclusions PEEP setting by VRI can improve lung compliance and oxygenation, reduce extravascular lung water, and have no adverse effects on hemodynamics.

关 键 词：振动反应成像 呼吸窘迫综合征 成人 正压呼吸 血管外肺水 

分 类 号：R563.8[医药卫生—呼吸系统]