两种膨肺技术在肌萎缩侧索硬化机械通气患者中的应用  

Application effect of two hyperinflation techniques in patients with amyotrophic lateral sclerosis undergoing mechanical ventilation

作　　者：袁聪 王海播 YUAN Cong;WANG Haibo(Respiratory intensive care unit,Henan Provincial People's Hospital/Zhengzhou University People's Hospital,Zhengzhou,Henan 450003,China)

机构地区：[1]河南省人民医院/郑州大学人民医院呼吸重症监护病房,河南郑州450003

出　　处：《临床肺科杂志》2023年第7期979-983,共5页Journal of Clinical Pulmonary Medicine

基　　金：河南省医学科技攻关计划普通项目(No.201602192)。

摘　　要：目的研究呼吸机膨肺(VHI)和复苏球囊膨肺(MHI)在肌萎缩侧索硬化(ALS)机械通气患者中的应用效果。方法采用随机对照研究方法,选取2018年1月-2021年12月河南省人民医院呼吸重症监护病房收治的65例ALS机械通气患者作为研究对象,5例患者因病情变化退出,最终纳入VHI组(n=30例)和MHI组(n=30例)。除常规胸部物理治疗外,患者入组后进行连续3天的膨肺,且每天早、中、晚各做一次膨肺,记录每次膨肺后的排痰量并计算出日均膨肺排痰量。同时,比较两组患者膨肺前及膨肺3天后通过胸部电阻抗成像技术(EIT)监测的“感兴趣区(ROI)”4区(ROI4)的潮气比例。结果膨肺3天后,VHI组患者的日均膨肺排痰量显著高于MHI组(P<0.05),两组患者ROI4区潮气比例较组内膨肺前均有显著增加(P<0.05),且VHI组ROI4区潮气比例的增加显著高于MHI组,组间差异有统计学意义(P<0.05)。结论对于ALS机械通气患者,VHI相较于MHI可清除更多的痰液和恢复更多因痰液堵塞导致肺背侧不张的区域。Objective To investigate the application effects of ventilator hyperinflation(VHI)and manual hyperinflation(MHI)in patients with amyotrophic lateral sclerosis(ALS)undergoing mechanical ventilation.Methods A randomized controlled study was conducted,65 patients with ALS undergoing mechanical ventilation admitted to the respiratory intensive care unit of Henan Provincial People's Hospital from January 2018 to December 2021 were selected as research objects.5 patients withdrew due to changes in disease condition and were eventually included in the VHI group(n=30 cases)and MHI group(n=30 cases).In addition to conventional chest physical therapy,patients were enrolled for three consecutive days of hyperinflation,once a day in the morning,afternoon,and evening.The amount of sputum excreted after each hyperinflation was recorded and the average daily amount of sputum excreted after each hyperinflation was calculated.Meanwhile,the tidal volume ratio of“region of interest”4(ROI4)monitored by electrical impedance imaging(EIT)before and 3 days after lung expansion was compared between the two groups.Results The average daily sputum volume production in the VHI group was significantly higher than that in the MHI group(P<0.05),There was no significant difference in ROI4 tidal volumes between the two groups at admission(P>0.05),The ROI4 tidal volumes in the two group was significantly increased after 3 days of hyperinflation(P<0.05),but the ROI4 tidal volumes in VHI group was significantly higher than that in MHI group,the difference between groups was statistically significant(P<0.05).Conclusion For patients with ALS undergoing mechanical ventilation,VHI can clear more sputum volumes and reinflate more areas of atelectasis at the dorsal of the lung due to sputum blockage than MHI.

关 键 词：呼吸机膨肺 复苏球囊膨肺 电阻抗断层成像技术 肌萎缩侧索硬化 

分 类 号：R744.8[医药卫生—神经病学与精神病学]