床旁超声对ARDS患者肺复张后的最佳PEEP设置研究  

The clinical research of setting of the best PEEP after lung recruitment in patients with ARDS by bedside ultrasound

作　　者：符珉[1] 李寒春[2] 

机构地区：[1]宜宾市第一人民医院超声科,四川宜宾644000 [2]宜宾市第一人民医院呼吸科,四川宜宾644000

出　　处：《西部医学》2016年第12期1748-1751,共4页Medical Journal of West China

基　　金：宜宾市科技局科研课题(2013YZY004)

摘　　要：目的探讨急性呼吸窘迫综合征(ARDS)患者肺复张(RM)后超声指导滴定最佳呼气末正压(PEEP)的可行性。方法将ICU病房中22例ARDS患者随机分为超声评分法组(LUS组)和氧合法组(OXY组)各11例,均以PEEP递增法实施RM,以LUS法评估RM终点,达到RM终点后稳定15min,分别以LUS法和OXY法选择最佳PEEP,LUS法以两次超声评分下降超过30%为终点,OXY法以氧合指数降低超过10%为终点,比较两组RM前、RM后15min及1、2h时的肺机械力学[气道峰压(Ppeak)、平均气道压(Pmean)、动态肺顺应性(Cdyn)]、血流动力学指标[平均动脉压(MAP)、心率(HR)、中心静脉压(CVP))及氧合指数(PaO2/FiO2)]。结果在PEEP递减过程中,再气化评分缓慢下降,直到出现一个明显的"跳跃"式下降(相邻两次评分下降≥30%)。LUS组选择的最佳PEEP为(15.2±1.7)cmH2O,OXY组选择的最佳PEEP为(13.5±2.8)cmH2O,LUS组高于OXY组(P<0.05)。LUS法选择的最佳PEEP作为滴定终点,LUS组PaO2/FiO2、Cdyn较OXY组改善更为明显(P<0.05)。RM后两组间HR、MAP、CVP比较,差异无统计学意义(P>0.05)。结论床旁超声作为ARDS患者RM后滴定最佳PEEP是可行的,有望在临床中进一步应用。Objective To explore the feasibility of assessment positive end expiratory pressure （PEEP） titration after lung recruitment （RM） in patients with acute respiratory distress syndrome （ARDS）by lung ultrasound. Methods 22 patients with ARDS were randomly divided into lung ultrasound evaluation group （LUS） and oxygenation group （OXY） with 11 cases in each group. All the groups were performed with PEEP increased lung treatment in lung recruitment. It was terminal point until the detection with LUS for the lung recruitment. At the terminal point, it was lasted fifteen minutes during PEEP increased lung treatment in lung recruitment. LUS group and OXY group set the best PEEP. It was terminal point until the detection with ultrasound score declined by more than 30% in twice with LUS or with oxygenation declined by more than 10% with OXY for the lung recruitment. The effects of PEEP on oxygenation and compliance of the respiratory system, hemodynamics indexes were monitored before RM and after RM （at 15 min, 1 h and 2 h） in the two groups. Results The regasification score decreased slowly with PEEP lever decreased, then an jump decrease change appeared （regasification score decreased≥30 % between two adjacent score）. LUS optimal PEEP was 15.2 ±1.7cmH2O, OXY optimal PEEP was 13.5d=2.8cmH2O. The optimal PEEP of LUS was higher than OXY（P〈0.05）. PaO2/FiO2 ,Cdyn of LUS group were more obvious improvement than that of OXY group （P〈0.05）. Conclusion Bedside ultrasound technology as a new best method can increase PEEP to promote lung recruitment to ARDS patients.

关 键 词：急性呼吸窘迫综合征(ARDS) 呼气末正压(PEEP) 肺复张(RM) 肺部超声 

分 类 号：R445.1[医药卫生—影像医学与核医学] R563.8[医药卫生—诊断学]