体外降低呼吸前负荷对急性呼吸窘迫综合征患者肺部机械能的影响  

Effect of extra corporeal reducing pre-load on pulmonary mechanical power in patients with acute respiratory distress syndrome

作　　者：张文稳 忽新刚 越丽霞 张杰 刘智达 高帅 赵志刚 梁新亮 Zhang Wenwen;Hu Xin'gang;Yue Lixia;Zhang Jie;Liu Zhida;Gao Shuai;Zhao Zhigang;Liang Xinliang(Department of Public Utilities Development,Henan Provincial People's Hospital,People's Hospital of Zhengzhou University,Zhengzhou 450003,Henan,China;Department of Respiratory and Critical Care Medicine,Henan Provincial People's Hospital,People's Hospital of Zhengzhou University,Zhengzhou 450003,Henan,China)

机构地区：[1]河南省人民医院(郑州大学人民医院)公共事业发展部,郑州450003 [2]河南省人民医院(郑州大学人民医院)呼吸与危重症医学科,郑州450003

出　　处：《中华危重病急救医学》2024年第12期1244-1248,共5页Chinese Critical Care Medicine

基　　金：河南省科技发展计划项目(212400410060)。

摘　　要：目的探讨静脉-静脉体外二氧化碳清除(V-V ECCO_(2)R)对接受无创通气的轻中度急性呼吸窘迫综合征(ARDS)患者肺部机械能和肺内气体分布的影响。方法采用回顾性研究方法,纳入2018年1月至2020年1月河南省人民医院协作医院通过96195平台危重症转运绿色通道转诊至呼吸重症监护病房(RICU)的60例轻中度ARDS合并肾功能不全患者,按照不同治疗方法分为常规治疗组和ECCO_(2)R组,每组30例。两组均给予原发病治疗、气道管理、无创通气等常规治疗。常规治疗组给予床旁连续性肾脏替代治疗(CRRT);ECCO_(2)R组给予V-V ECCO_(2)R治疗。记录患者性别、年龄、发病原因、急性生理学与慢性健康状况评分Ⅱ(APACHEⅡ)等一般资料;分别于治疗12 h和24 h抽取患者股动脉血进行血气分析,记录动脉血氧分压(PaO_(2))、动脉血二氧化碳分压(PaCO_(2))和氧合指数(PaO_(2)/FiO_(2)),记录呼吸力学参数〔潮气量、呼吸频率、最大吸气压(MIP)和最大呼气压(MEP)〕,计算浅快呼吸指数(RSBI);采用肺电阻抗成像(EIT)技术测定治疗12 h和24 h肺部感兴趣区域(ROI)值,计算肺部机械能。结果常规治疗组和ECCO_(2)R组患者治疗24 h动脉血气分析指标、呼吸力学参数和肺部机械能均较治疗12 h明显改善(均P<0.05);且ECCO_(2)R组治疗12 h和24 h PaCO_(2)、RSBI、总机械能、非重力依赖区机械能均较常规治疗组明显降低〔PaCO_(2)(mmHg,1 mmHg≈0.133 kPa):治疗12 h为44.03±2.96比49.96±2.50,治疗24 h为41.65±3.21比48.53±2.33;RSBI(次·min^(-1)·L^(-1)):治疗12 h为88.67±4.05比92.35±4.03,治疗24 h为77.66±4.64比90.98±4.21;总机械能(mJ):治疗12 h为10.40±1.15比12.93±1.68,治疗24 h为11.13±1.18比14.05±1.69;非重力依赖区机械能(mJ):治疗12 h为7.15±0.84比7.98±0.75,治疗24 h为7.77±0.93比9.13±1.10〕,MEP和MIP均较常规治疗组明显升高〔MEP(cmH_(2)O,1 cmH_(2)O≈0.098 kPa):治疗12 h为89.88±5.04比86.09±5.57,治疗24 h为96.5Objective To explore the effects of veno-venous extra corporeal carbon dioxide removal(V-V ECCO_(2)R)on local mechanical power and gas distribution in the lungs of patients with mild to moderate acute respiratory distress syndrome(ARDS)receiving non-invasive ventilation.Methods Retrospective research methods were conducted.Sixty patients with mild to moderate ARDS complicated with renal insufficiency who were transferred to the respiratory intensive care unit(RICU)through the 96195 platform critical care transport green channel from January 2018 to January 2020 at the collaborative hospitals of Henan Provincial People's Hospital were enrolled.According to different treatment methods,they were divided into a conventional treatment group and an ECCO_(2)R group,with 30 patients in each group.Both groups received standard treatments including primary disease treatment,airway management,and non-invasive ventilation.The conventional treatment group received bedside continuous renal replacement therapy(CRRT),and the ECCO_(2)R group received V-V ECCO_(2)R treatment.General information of patient such as gender,age,cause of disease,and acute physiology and chronic health evaluationⅡ(APACHEⅡ)were recorded;arterial blood gas analysis was performed before treatment and at 12 hours and 24 hours during treatment,recording arterial partial pressure of oxygen(PaO_(2)),arterial partial pressure of carbon dioxide(PaCO_(2)),and oxygenation index(PaO_(2)/FiO_(2)).Respiratory mechanics parameters[tidal volume,respiratory rate,maximal inspiratory pressure(MIP),and maximal expiratory pressure(MEP)]were recorded,and the rapid shallow breathing index(RSBI)was calculated;electrical impedance tomography(EIT)was used to measure regional of interest(ROI)values in different lung areas at 12 hours and 24 hours of treatment,and the pulmonary mechanical energy was calculated.Results The arterial blood gas analysis indicators,respiratory mechanics parameters,and pulmonary mechanical energy of patients in the conventional treatment group and E

关 键 词：静脉-静脉体外二氧化碳清除 急性呼吸窘迫综合征 机械能 电阻抗成像技术 

分 类 号：R563.8[医药卫生—呼吸系统]