ICU医护人员ARDS肺保护通气策略依从性的现状调查  

The investigation on the compliance of intensive care unit medical staff with acute respiratory distress syndrome lung protective ventilation strategy

作　　者：陈小潍 史加海[1] 徐梦瑶 许惠芬[3] 董洪利 翟怀香[4] 李晶 王小丹 顾晓成 陆相君 吴春娟 Chen Xiaowei;Shi Jiahai;Xu Mengyao;Xu Huifen;Dong Hongli;Zhai Huaixiang;Li Jing;Wang Xiaodan;Gu Xiaocheng;Lu Xiangjun;Wu Chunjuan(Nantong University,Nantong 226001,Jiangsu,China;Affiliated Maternity&Child Health Care Hospital of Nantong University,Nantong 226007,Jiangsu,China;Department of Intensive Care Unit,Affiliated Hospital of Nantong University,Nantong 226006,Jiangsu,China;Department of Intensive Care Unit,the First People's Hospital of Lianyungang,Lianyungang 222001,Jiangsu,China;Department of Intensive Care Unit,Xuzhou Mining Group General Hospital,Xuzhou 221000,Jiangsu,China;Department of Intensive Care Unit,the Second People's Hospital of Nantong,Nantong 226002,Jiangsu,China;Department of Intensive Care Unit,Zhenjiang First People's Hospital,Zhenjiang 212002,Jiangsu,China;Department of Intensive Care Unit,the Sixth People's Hospital of Nantong,Nantong 226002,Jiangsu,China;Department of Intensive Care Unit,Taixing People's Hospital,Taizhou 225400,Jiangsu,China)

机构地区：[1]南通大学,江苏南通226001 [2]南通大学附属南通妇幼保健院,江苏南通226007 [3]南通大学附属医院ICU,江苏南通226006 [4]连云港市第一人民医院ICU,江苏连云港222001 [5]徐州矿务集团总医院ICU,江苏徐州221000 [6]南通市第二人民医院ICU,江苏南通226002 [7]镇江市第一人民医院ICU,江苏镇江212002 [8]南通市第六人民医院ICU,江苏南通226002 [9]泰兴市人民医院ICU,江苏泰州225400

出　　处：《中国中西医结合急救杂志》2023年第3期267-270,共4页Chinese Journal of Integrated Traditional and Western Medicine in Intensive and Critical Care

基　　金：江苏省南通市科技计划项目(MSZ20081)。

摘　　要：目的通过调查分析重症监护病房(ICU)医护人员对急性呼吸窘迫综合征(ARDS)肺保护通气策略(LPVS)应用的依从性,以改进临床ARDS LPVS的规范实施。方法回顾性调查2021年1月至2022年12月入住江苏省内8家医院ICU进行有创机械通气ARDS患者的临床资料,通过自制的ARDS LPVS实施监测量表,收集患者性别、年龄、身高、理想体质量(IBW),以及机械通气6 h的呼吸机参数〔模式、潮气量(VT)、呼气末正压(PEEP)、吸入氧浓度(FiO2)〕等相关指标。根据ARDS患者机械通气是否按照目标VT≤6 mL/kg(IBW),以及PEEP设置水平是否符合ARDS临床研究网络(ARDSnet)推荐FiO2-PEEP对应量表作为评价ARDS LPVS的标准,评估不同级别医院ICU医护人员对ARDS LPVS临床实施的依从性。结果纳入调查的357例ARDS机械通气患者中,VT设置均值为(6.17±1.02)mL/kg,其中204例患者按照VT≤6 mL/kg(IBW)设置,依从性为57.14%;三级医院VT设置低于二级医院(mL/kg:6.06±1.05比6.33±0.97,P<0.05),三级医院VT设置的依从性较二级医院更好〔61.84%(128/207)比50.67%(76/150),P<0.05〕。PEEP设置区间在3~16 cmH_(2)O(1 cmH_(2)O≈0.098 kPa),PEEP均值为(6.52±2.53)cmH_(2)O,其中199例患者的PEEP设置符合ARDSnet推荐的FiO2-PEEP对应量表,依从性占比为55.74%;三级医院PEEP设置高于二级医院(cmH_(2)O:6.95±2.13比5.94±2.91,P<0.05);三级医院PEEP设置的依从性高于二级医院〔67.63%(140/207)比39.33%(59/150),P<0.05〕。更为明显的是,在PEEP设置<5 cmH_(2)O的38例患者中,二级医院占94.74%(36例),其PEEP设置的不规范程度远高于三级医院〔60.67%(91/150)比32.37%(67/207),P<0.05〕。结论小潮气量(LVT)及合适PEEP的设置是规范实施ARDS LPVS的基础,是预防和减少呼吸机相关肺损伤(VILI)的关键。但从本次调查的情况来看,临床依从性并不乐观,尤其是二级医院在ARDS LPVS临床实施中与三级医院相比存在较大的差距。因此,需要重视ICU医护人员ARDS LPVS的�Objective To investigate and analyze the compliance of intensive care unit(ICU)medical staff with acute respiratory distress syndrome(ARDS)lung protective ventilation strategy(LPVS),and improve the standardized implementation of ARDS LPVS in clinical practice.Methods The clinical data of ARDS patients with invasive mechanical ventilation admitted to ICU from 8 hospitals in Jiangsu Province was retrospectivly survey.Gender,age,height,ideal body weight(IBW),and 6-hour mechanical ventilation[mode,tidal volume(VT),positive endexpiratory pressure(PEEP),fraction of inspired oxygen(FiO2)]were collected by a self-made ARDS LPVS monitoring table.According to whether the mechanical ventilation of ARDS patients is based on the target VT≤6 mL/kg(IBW),and whether the level of PEEP was in line with the FiO2-PEEP corresponding scale recommended by ARDS Clinical Research Network(ARDSnet)as the standard for evaluating ARDS LPVS,to evaluate the compliance of ICU medical staff with the clinical implementation of ARDS LPVS in different levels of hospitals.Results Among 357 ARDS mechanical ventilation patients included,mean VT setting was(6.17±1.02)mL/kg,of which 204 patients were set with VT≤6 mL/kg(IBW),with compliance of 57.14%.The VT setting was lower in tertiary hospitals than that in secondary hospitals(mL/kg:6.06±1.05 vs.6.33±0.97,P<0.05),and the compliance of VT setting in tertiary hospitals was better than that in secondary hospitals[61.84%(128/207)vs.50.67%(76/150),P<0.05].The PEEP setting ranged from 3-16 cmH_(2)O(1 cmH_(2)O≈0.098 kPa),and the mean value was(6.52±2.53)cmH_(2)O.The PEEP settings of 199 patients complied with the FiO2-PEEP scale recommended by ARDSnet,and the corresponding compliance rate was 55.74%.The PEEP setting was higher in tertiary hospitals than that in secondary hospitals(cmH_(2)O:6.95±2.13 vs.5.94±2.91,P<0.05).The compliance of PEEP setting was better in tertiary hospitals than that in secondary hospitals[67.63%(140/207)vs.39.33%(59/150),P<0.05].It is worth noting that the PEEP settings

关 键 词：急性呼吸窘迫综合征 肺保护通气策略 依从性 小潮气量 呼气末正压 

分 类 号：R563[医药卫生—呼吸系统]