ARDS患者右心功能最佳PEEP与氧合最佳PEEP关系的研究  

ASSOCIATION BETWEEN RIGHT CARDIAC FUNCTION PARAMETERS AND OPTIMAL POSITIVE END-EXPIRATORY PRESSURE TITRATED AFTER LUNG RECRUITMENT MANEUVER IN MECHANICALLY VENTILATED PATIENTS WITH ACUTE RESPIRATORY DISTRESS SYNDROME

作　　者：张海燕[1] 姚波[1] 李连弟[1] ZHANG Haiyan;YAO Bo;LI Liandi(Department of Critical Care Medicine, The Affiliated Hospital of Qingdao University, Qingdao 266003, China)

机构地区：[1]青岛大学附属医院重症医学科,山东青岛266003

出　　处：《精准医学杂志》2020年第4期363-366,共4页Journal of Precision Medicine

摘　　要：目的探讨急性呼吸窘迫综合征(ARDS)患者右心功能最佳呼气末正压(PEEP)与肺复张后氧合最佳PEEP的关系。方法对ARDS患者进行肺复张后,PEEP由1.96 kPa递减至0.196 kPa,每次调整PEEP后5 min均进行血气监测,并行心脏彩超测量心脏三尖瓣环位移(TAPSE)、脉冲多普勒心脏舒张早期三尖瓣血流速度与组织多普勒心脏舒张早期三尖瓣环运动速度的比值(E/e′)、Tei指数及右心室内径等。规定血气分析中PO2/FiO2较前一次下降大于10%,提示肺泡开始塌陷,该PEEP+0.196 kPa被认为是最佳PEEP。结果组内相关系数(ICC)法:TAPSE最大值、E/e′最小值、Tei最小值、右心室内径最小值所对应PEEP与氧合法最佳PEEP的ICC分别为0.734(P<0.05)、0.810(P<0.05)、0(P>0.05)、0(P>0.05),TAPSE最大值、E/e′最小值对应PEEP与氧合法最佳PEEP一致性较好。配对t检验法:TAPSE最大值、E/e′最小值、Tei指数最小值及右心室内径最小值对应的PEEP与氧合最佳PEEP相比,均数差值分别为:1.0(P=0.033)、-0.2(P=0.682)、0.2(P=0.762、-1.4(P=0.076),E/e′最小值对应的PEEP、Tei指数最小值对应的PEEP与氧合法最佳PEEP一致性较好。结论对于ARDS患者,肺复张后床旁超声监测E/e′最小值可以作为氧合法滴定最佳PEEP的替代方法,且具有经济、无创、快速的特点。Objective To investigate the association between right heart function parameters and optimal positive end-expiratory pressure(PEEP)titrated after lung recruitment maneuver(RM)in mechanically ventilated patients with acute respiratory distress syndrome(ARDS).Methods PEEP value for ARDS patients was gradually reduced from 1.96 kPa to 0.196 kPa after RM,and blood gas analysis was performed at 5 minutes after each adjustment.Echocardiography was performed to measure tricuspid annular plane systolic excursion(TAPSE),E/e′ratio,Tei index,and right ventricular internal dimension.A reduction of>10%in PO2/FiO2 compared with the previous time suggested the collapse of alveoli,and this PEEP value+0.196 kPa was consi-dered the optimal PEEP value.Results According to the intraclass correlation coefficient(ICC)method,the ICCs of maximum TAPSE,minimum E/e′,minimum Tei index,and minimum right ventricular internal dimension with optimal PEEP were 0.734(P<0.05),0.810(P<0.05),0(P>0.05),and 0(P>0.05),respectively,and there was a good consistency between the PEEP values corresponding to maximum TAPSE and minimum E/e′and the optimal PEEP value based on the oxygen index method.According to the paired t-test,mean differences between the PEEP values corresponding to maximum TAPSE,minimum E/e′,minimum Tei index,and minimum right ventricular internal dimension and the optimal PEEP value were 1.0(P=0.033),-0.2(P=0.682),0.2(P=0.762),and-1.4(P=0.076),respectively,and there was a good consistency between the PEEP values corresponding to minimum E/e′and minimum Tei index and the optimal PEEP value based on the oxygen index method.\ConclusionFor ARDS patients,bedside monitoring of minimum E/e′by echocardiography after RM can be used as an alternative method for the titration of optimal PEEP by the oxygen index method.

关 键 词：呼吸窘迫综合征 成人 肺复张 正压呼吸 滴定分析法 心室功能 右 血气分析 

分 类 号：R563.8[医药卫生—呼吸系统]