床旁实时浓度监测氦气稀释法检测功能残气量的实验观察  

Monitoring of functional residual capacity by bedside real-time concentration via helium dilution technique

作　　者：刘奇[1] 陈荣昌[2] 贾留群[1] 王欢[1] 李雯[3] 曾庆思[3] 程哲[1] 

机构地区：[1]郑州大学第一附属医院呼吸与重症科河南省高等学校临床医学重点学科开放实验室,450052 [2]广州呼吸疾病研究所呼吸疾病国家重点实验室广州医科大学第一附属医院 [3]广州医科大学第一附属医院放射科

出　　处：《中华医学杂志》2015年第27期2208-2213,共6页National Medical Journal of China

基　　金：国家自然科学基金青年基金（81400051）

摘　　要：目的探讨床旁实时浓度监测氦气稀释法（RHe法）检测功能残气量的准确性、精度及重复性。方法选择18例健康比格犬，利用静脉注射油酸制作急性呼吸窘迫综合征（ARDS）动物模型，在制作动物模型前后采用床旁RHe法及胸部CT扫描法检测功能残气量，实验过程中，实时监测实验动物呼吸、心率、血压等生命体征，选用Bland-Altman分析法及配对t检验进行统计学分析。结果对于造模前健康肺，CT扫描法检测功能残气量（FRCCT）与床旁RHe法检测功能残气量（FRCRHe）呈线性相关，回归方程为FRCRHe=0．959×FRCCT＋23．3（R^2=0．89，P〈0．0001）。RHe法与CT法的偏倚为（6．3±27．6）ml（1．5％±7．1％），95％可信区间为-47．7-60．3ml；对于造模后ARDS肺，直线回归方程为FRCRHe=0．693×FRCCT＋66．4（R^2=0．507，P〈0．001）。RHe法与CT法的偏倚为（7．9±27．1）ml（4．5％±13．6％），95％可信区间为-45．3～61．1ml。两次FRCRHe之间的差别在健康肺和ARDS肺分别为（-0．1％±5．8％）和（0．2％±9％）。结论床旁RHe法用于检测健康及ARDS模型肺功能残气量均具有良好的准确性、精度及重复性。Objective To explore the accuracy, precision and repeatability of bedside real-time concentration monitoring via helium dilution （ RHe ） in ventilated dogs with and without acute respiratory distress syndrome （ARDS）. Methods Functional residual capacity （FRC） measurements were performed with computer tomography （FRCcT） and RHe （FRCRHe ） in 18 adult male beagle dogs. Blood gas analysis was conducted for baseline, post-lung injury and end-of-experiment. Vital signs were monitored continuously. And the differences were compared between two techniques and repeated FRCRHe s. Results For healthy lungs, FRCCT and FRCRHe were linearly correlated （ R^2 = 0. 89, P 〈 0.0001 ）. Bias between FRCRHe and FRCCT was 6. 3 ±27. 6 ml （1.5% ±7. 1% ） with 95% confidence interval limits of -47. 7 and 60. 3 ml respectively. For ARDS lung, FRCRHe = 0. 693 × FRCCT ± 66.4 （R^2 = 0. 507, P 〈 0. 00 1 ）. Bias between FRCRHe and FRCcT was 7, 9 ± 271 ml （4. 5% ± 13.6% ） with 95% confidence interval limits of -45.3 and 61.1 ml respectively. And the differences of repeated FRCRnes were -0. 1% ± 5.8% and 0.2% ± 9% in normal and ARDS lungs respectively. Conclusion The technique of bedside RHe may be used for measuring FRC with excellent accuracy, precision and repeatability.

关 键 词：功能残气量 氦 指示剂稀释技术 呼吸窘迫综合征 肺 

分 类 号：R563.8[医药卫生—呼吸系统]