新型冠状病毒感染ARDS患者EIT监测下俯卧位通气成像的改变  

Prone positioning improves ventilation distribution and ventilation-perfusion matching assessed by electrical impedance tomography in COVID-19 patients with ARDS

作　　者：王晶晶[1] 谢晖[1] 邓璞钰 张晨晨 田学 谢云 王瑞兰[1] Wang Jingjing;Xie Hui;Deng Puyu;Zhang Chenchen;Tian Xue;Xie Yun;Wang Ruilan(Department of Critical Care Medicine,Shanghai General Hospital of Nanjing Medical University,Shanghai Jiaotong University,School of Medicine,Shanghai 201620,China)

机构地区：[1]南京医科大学附属上海一院临床医学院,上海交通大学附属第一人民医院急诊危重病科,上海201620

出　　处：《中华重症医学电子杂志》2024年第1期31-37,共7页Chinese Journal Of Critical Care & Intensive Care Medicine(Electronic Edition)

基　　金：上海申康医院发展中心临床三年行动计划资助(SHDC2020CR2013A,SHDC2020CR5010-003)

摘　　要：目的通过电阻抗断层成像(EIT)动态评估新型冠状病毒(简称新冠病毒)感染急性呼吸窘迫综合征(ARDS)患者俯卧位通气(PP)的生理效应,并确定其肺保护的预测因素。方法本前瞻性研究共纳入2022年12月至2023年2月入住上海交通大学附属第一人民医院ICU的15例采用PP治疗的新冠病毒感染ARDS患者。收集PP开始前(T0)、PP开始后2 h(T1)、PP结束后(T2)3个时间节点所有患者动脉血气(ABG)分析结果、呼吸机参数和血流动力学参数,包括心率(HR)、平均动脉压(MAP),同时进行EIT记录。结果经过PP治疗,PaO2/FiO2逐渐上升[T0 vs T1 vs T2:(173.17±17.73)vs(257.05±57.39)vs(299.03±71.18)mmHg,P<0.001],分钟通气量(MV)显著上升[T0 vs T1 vs T2:(8.14±2.38)vs(8.89±1.29)vs(11.40±1.91)L/min,P<0.001],Crs显著上升[T0 vs T1 vs T2:(27.63±7.50)vs(30.60±7.40)vs(31.53±8.29)ml/cmH2O,P=0.041],差异均有统计学意义。背侧通气占比增加[T0 vs T1 vs T2:(39.87±18.74)%vs(62.20±18.70)%vs(51.40±18.43)%,P=0.001],差异有统计学意义。与PP开始前(T0)比较,PP开始后2 h(T1)通气-灌注匹配显著提高[T0 vs T1(66.67±12.81)%vs(78.24±10.60)%,P=0.03],差异有统计学意义。结论PP改善了新冠病毒感染ARDS患者肺部Crs与通气分布均一性,改善通气-灌注匹配。Objective To assess the impact of prone positioning(PP)on lung ventilation and perfusion in COVID-9 patients with moderate to severe acute respiratory distress syndrome(ARDS)using electrical impedance tomography(EIT),to investigate the effects of PP on the distribution of ventilation and oxygenation in non-intubated patients.Methods This prospective study comprised 15 patients with COVID-19 ARDS who received treatment in the prone position and were admitted to the Critical Care Medicine Department of Shanghai General Hospital,affiliated with Shanghai Jiaotong University,between December 2022 and February 2023.Arterial blood gas(ABG)analysis,ventilator parameters,and hemodynamic parameters of all patients at three-time points before the start of the prone position(T0),2 hours after the start of the prone position(T1),2 hours after the end of the prone position(T2)were collected.Measurements of heart rate(HR),mean arterial pressure(MAP),and EIT recordings were conducted simultaneously at T0,T1,and T2.Results After prone positioning,PaO2/FiO2 increased significantly[T0 vs T1 vs T2:(173.17±17.73)mmHg vs(257.05±57.39)mmHg vs(299.03±71.18)mmHg,F=15.270,P<0.001].Additionally,there was an increase in the proportion of dorsal ventilation after PPV[T0 vs T1 vs T2:(39.87±18.74)%vs(62.20±18.70)%vs(51.40±18.43)%,F=9.340,P=0.001].The minute ventilation(MV)was significantly increased[T0 vs T1 vs T2:(8.14±2.38)L/min vs(8.89±1.29)L/min vs(11.40±1.91)L/min,F=22.917,P<0.001,respectively].Similarly,respiratory compliance(Crs)showed a substantial improvement at different time points[T0 vs T1 vs T2:(27.63±7.50)ml/cmH2O vs(30.60±7.40)ml/cmH2O vs(31.53±8.29)ml/cmH2O,F=3.582,P=0.041,respectively].The ventilation-perfusion matching showed a substantial improvement after PP compared to before PP[T0 vs T1:(66.67±12.81)%vs(78.24±10.60)%,P=0.03].Conclusion PP improves the uniformity of ventilation distribution and ventilation-perfusion matching in patients with COVID-19 ARDS.

关 键 词：急性呼吸窘迫综合征 电阻抗断层成像 俯卧位通气 新型冠状病毒感染 

分 类 号：R563.8[医药卫生—呼吸系统]