俯卧位经鼻高流量氧疗对轻中度急性呼吸窘迫综合征患者跨肺压的改善作用  

Effect of high-flow nasal cannula oxygen therapy in prone position on improving transpulmonary pressure in patients with acute respiratory distress syndrome

作　　者：魏然[1] 贾金广 朱婉凌[1] 韩蕾 忽新刚 WEI Ran;JIA Jinguang;ZHU Wanling;HAN Lei;HU Xingang(Department of Respiratory and Critical Care Medicine,Zhengzhou People's Hospital,Zhengzhou,Henan 450053,China;Department of General Practice,Henan Provincial People's Hospital,Zhengzhou University People's Hospital,Zhengzhou,Henan 450003,China;Department of Respiratory and Critical Care Medicine,Henan Provincial People's Hospital,Zhengzhou University People's Hospital,Zhengzhou,Henan 450003,China)

机构地区：[1]郑州人民医院呼吸与危重症医学科,河南郑州450053 [2]河南省人民医院郑州大学人民医院全科医学科,河南郑州450003 [3]河南省人民医院郑州大学人民医院呼吸与危重症医学科,河南郑州450003

出　　处：《中华实用诊断与治疗杂志》2024年第5期498-502,共5页Journal of Chinese Practical Diagnosis and Therapy

摘　　要：目的 探讨轻中度急性呼吸窘迫综合征(ARDS)患者采用俯卧位经鼻高流量氧疗在改善氧合、跨肺压中的作用。方法 2016年1月—2019年12月河南省人民医院行经鼻高流量氧疗的轻中度ARDS患者46例,23例采用俯卧位者为观察组,23例采用平卧位或侧卧位者为对照组。2组入院后均根据病情给予抗感染、治疗原发病、气道管理等常规治疗,保证血流动力学和内环境稳定,应用小剂量激素、中性粒细胞弹性蛋白酶抑制剂等治疗ARDS。2组上机后均经鼻腔置入食管测压管,监测食道压和气道压,计算上机12、24 h时吸气末跨肺压、呼气末跨肺压、跨肺驱动压;应用肺部电阻抗断层成像监测仪记录上机12、24 h时非重力依赖区、重力依赖区机械能。比较2组ARDS病因、ARDS程度、入院时急性生理学及慢性健康状况Ⅱ(APACHEⅡ)评分等临床资料;记录上机12、24 h时pa(O_(2))、pa(CO_(2))、氧合指数。结果 (1)2组男性及中度ARDS比率、年龄、ARDS病因、入院时APACHEⅡ评分、ARDS治疗药物比较差异均无统计学意义(P>0.05)。(2)上机12、24 h时,观察组pa(O_(2))[(62.01±2.66)、(64.68±2.87)mmHg]、氧合指数[(141.69±7.98)、(159.83±11.87)mmHg]、重力依赖区机械能[(5.56±0.59)、(7.56±0.94)mJ]均高于对照组[(60.05±4.51)、(62.44±2.35)mmHg;(135.05±8.53)、(139.62±12.63)mmHg;(3.92±0.56)、(4.70±0.67)mJ](P<0.05),pa(CO_(2))[(44.07±2.87)、(41.73±2.87)mmHg]、吸气末跨肺压[(11.26±1.98)、(6.77±1.77)cmH_(2)O]、呼气末跨肺压[(1.58±0.30)、(-1.88±0.66)cmH_(2)O]、跨肺驱动压[(8.55±2.19)、(7.44±1.84)cmH_(2)O]均低于对照组[(49.45±2.66)、(48.30±2.50)mmHg;(12.98±1.96)、(10.40±2.40)cmH_(2)O;(1.98±0.60)、(-1.59±0.18)cmH_(2)O;(11.77±2.71)、(10.49±2.37)cmH_(2)O](P<0.05),非重力依赖区机械能与对照组比较差异均无统计学意义(P>0.05)。2组上机24 h时pa(O_(2))、pa(CO_(2))、氧合指数、吸气末跨肺压、呼气末跨肺压、跨肺驱动�Objective To investigate the role of high-flow nasal cannula oxygen therapy in prone position in improving oxygenation and transpulmonary pressure in patients with acute respiratory distress syndrome(ARDS).Methods From January 2016 to December 2019,46 patients with mild to moderate ARDS underwent high-flow nasal cannula oxygen therapy in Henan Provincial People's Hospital,among whom 23 patients received treatment in prone position(observation group)and another 23 patients received treatment in supine or lateral position(control group).After admission,both groups were given conventional treatment according to their serverity of disease,including anti-infection,treatment of primary disease and airway management to ensure hemodynamic and internal environmental stability,and administrations of small doses of glucocorticoids and neutrophil elastase inhibitors to treat ARDS.After starting ventilation,an esophageal pressure measurement tube was inserted through the nasal cavity to detect esophageal and airway pressures,and the end-inspiratory transpulmonary pressure,end-expiratory transpulmonary pressure,and transpulmonary driving pressure were calculated 12 and 24 h after starting ventilation.Lung electrical impedance tomography was used to monitor the mechanical power in non-gravitational dependent and gravitational dependent lung regions 12 and 24 h after starting ventilation.The clinical data as etiology,degree of ARDS and Acute Physiology and Chronic Health Evaluation Ⅱ(APACHEⅡ)were compared between two groups,and pa(O_(2)),pa(CO_(2))and oxygenation index were recorded 12 and 24 h after starting ventilation.Results(1)There were no significant differences in the male ratio,proportion of moderate ARDS,age,etiology,admission APACHEⅡ score and drugs for ARDS between two groups(P>0.05).(2)The values of pa(O_(2)),oxygenation indexes,mechanical power values in gravitational dependent lung region were higher in observationgroup[(62.01±2.66),(64.68±2.87)mmHg;(141.69±7.98),(159.83±11.87)mmHg;(5.56±0.59),(7.56±0.9

关 键 词：急性呼吸窘迫综合征 经鼻高流量氧疗 俯卧位 电阻抗成像技术 跨肺压 

分 类 号：R563.8[医药卫生—呼吸系统]