振动反应成像技术在急性呼吸窘迫综合征患者肺复张评估中的应用  

Vibration response imaging for assessment of lung recruitment in patients with acute respiratory distress syndrome

作　　者：王丽[1] 宋宁宁[2] 孙丽华[1] 刘云[1] 谭焰[1] WANG Li;SONG Ning-ning;SUN Li-hua;LIU Yun;TAN Yan(Department of Pulmonary and Critical Care Medicine,Nanjing Medical University,Nanjing 210006,Jiangsu,China;Equipment Section,Nanjing First Hospital,Nanjing Medical University,Nanjing 210006,Jiangsu,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,南京医学硕士210006 [2]南京医科大学附属南京医院(南京市第一医院)设备科,南京210006

出　　处：《医学研究生学报》2019年第3期263-267,共5页Journal of Medical Postgraduates

基　　金：南京市卫生局科技发展重点项目(ZKX15025)

摘　　要：目的振动反应成像技术(VRI)已用于重症患者的床旁监测,实时显示呼吸过程中肺复张及通气情况。文中旨在探讨VRI在急性呼吸窘迫综合征(ARDS)患者肺复张评估中的应用价值。方法选取2015年1月至2017年6月南京医科大学附属南京医院呼吸与危重症医学科20例ARDS患者。患者呼气末正压通气(PEEP)从5增加至15 cmH_2O,统计分析VRI图像最大能量图平均灰度值、肺部定量数值(QLD)等,并分析VRI图像与肺复张容积及氧合指数的相关性。结果与PEEP5 cmH2O比较,PEEP 15 cmH_2O的VRI图像最大能量图平均灰度值下降[(175.1±15.9) vs (169.1±11.3)],图像面积占比显著增加[(52.7±7.5)%vs (56.3±4.4)%],差异有统计学意义(P<0.05),肺部定量数值(QLD)左上、左中显著降低,左下、右下显著升高(P<0.05)。PEEP 15 cmH_2O的VRI图像平均灰度较PEEP 5 cmH_2O增加-5.6±12.8,增加值与肺复张容积呈负相关(r=-0.785,P<0.01);图像面积占比增加(3.8±4.8)%,增加值与肺复张容积呈正相关(r=0.793,P<0.01)。PEEP 5、15 cmH_2O时,患者氧合指数分别为(116.3±25.6)、(175.4±33.5) mmHg,改善值与VRI图像的平均灰度增加值呈负相关(r=-0.740,P<0.01),与图像面积占比增加值正相关(r=0.581,P<0.01)。结论 VRI可作为评估ARDS患者肺复张效应的有效方法。Objective Vibration response imaging(VRI)has been applied to the bedside monitoring of critically ill patients. The purpose of this study was to explore the value of VRI in assessing lung recruitment in patients with acute respiratory distress syndrome(ARDS). Methods We prospectively studied the clinical data on 20 cases of ARDS treated in our Department of Pulmonary and Critical Care Medicine from January 2015 to June 2017. The positive end-expiratory pressure(PEEP)of the patients was increased from 5 and 15 cm H2O,the mean grey value of the max energy frame of VRI was determined,the quantitative lung data (QLD)were obtained,and the correlation of the VRI image with the recruited lung volume and oxygenation index was analyzed. Results The patients with PEEP at 15 cm H2O,in comparison with those with PEEP at 5 cm H2O,showed a significantly decreased mean gray value of the max energy frame of VRI(169.1 ± 11.3 vs 175.1 ± 15.9,P = 0.04),increased gray area([56.3 ± 4.4]% vs[52.7 ± 7.5]%,P < 0.05),declined QLD in the upper left and left middle regions(P < 0.05) and elevated in the lower left and lower right regions(P <0.05). With the PEEP at 15 cm H2O,the mean gray value of VRI was increased by -5.6 ± 12.8,negatively correlated with the recruited lung volume(r =-0.785,P < 0.01),and the gray area increased(3.8 ± 4.8)%,positively correlated with the recruited lung volume( r =0.793,P < 0.01). With PEEP at 5 and 15 cm H2O,the oxygenation indexes were(116.3 ± 25.6)mmHg and(116.3 ± 25.6) mmHg,respectively,the improvement rate of which correlated negatively with the increased mean gray value of VRI(r =-0.740,P < 0.01)but positively with the gray area(r = 0.581,P < 0.01). Conclusion Lung recruitment can be adequately estimated with bedside VRI in patients with ARDS.

关 键 词：振动反应成像 急性呼吸窘迫综合征 肺复张 呼气末正压 

分 类 号：R563[医药卫生—呼吸系统]