中华医学杂志
中華醫學雜誌
중화의학잡지
National Medical Journal of China
2015年
19期
1448-1452
,共5页
王艺萍%肖菲%黎嘉嘉%蒲虹%黄晓波
王藝萍%肖菲%黎嘉嘉%蒲虹%黃曉波
왕예평%초비%려가가%포홍%황효파
呼吸窘迫综合征,成人型%超声检查%俯卧位%机械通气
呼吸窘迫綜閤徵,成人型%超聲檢查%俯臥位%機械通氣
호흡군박종합정,성인형%초성검사%부와위%궤계통기
Respiratory distress syndrome,adult%Uhrasonography%Prone position%Mechanical ventilation
目的 用肺部超声评估重度急性呼吸窘迫综合征(ARDS)患者俯卧位通气不同时间点肺通气状况的改变,以确定俯卧位通气的最佳维持时间.方法 收集2012年10月至2014年6月四川省人民医院重症医学科(ICU)收治的78例重度ARDS患者为研究对象,连续行俯卧位通气5d,每天8h.记录每次俯卧位即刻(T0)、2 h(T1)、4 h(T2)、6 h(T3)、8 h(T4)的肺通气评分和动脉血气分析[包括酸碱度(pH)值、动脉血氧分压(PaO2)、二氧化碳分压(PaCO2)及氧合指数(PaO2/FiO2)],观察患者俯卧位通气时不良反应、7d后的机械通气状态、氧合指数及28 d存活率.结果 与T0比较,俯卧位T1、T2、T3、T4点肺重力依赖区的肺通气评分均呈下降趋势,大部分区域俯卧位2h后的肺通气评分即有明显改善(P＜0.05),4h后肺通气评分继续改善不明显(P＞0.05);T1、T2、T3、T4的PaO2、PaO2/FiO2均高于T0(P＜0.05),T2的PaO2/FiO2高于T1(t=2.840,P＜0.05),其余相邻两点的PaO2、PaO2/FiO2相比,差异无统计学意义(P＞0.05);俯卧位5d后65例(83.3％)患者氧合指数＞ 300 mmHg;7d后30例(38.5％)患者可以脱机;28 d死亡率为7例(8.97％).结论 俯卧位通气2～4h可显著改善重度ARDS患者肺重力依赖区的通气状况,超过4h的俯卧位通气可能并不能带来更多的益处.
目的 用肺部超聲評估重度急性呼吸窘迫綜閤徵(ARDS)患者俯臥位通氣不同時間點肺通氣狀況的改變,以確定俯臥位通氣的最佳維持時間.方法 收集2012年10月至2014年6月四川省人民醫院重癥醫學科(ICU)收治的78例重度ARDS患者為研究對象,連續行俯臥位通氣5d,每天8h.記錄每次俯臥位即刻(T0)、2 h(T1)、4 h(T2)、6 h(T3)、8 h(T4)的肺通氣評分和動脈血氣分析[包括痠堿度(pH)值、動脈血氧分壓(PaO2)、二氧化碳分壓(PaCO2)及氧閤指數(PaO2/FiO2)],觀察患者俯臥位通氣時不良反應、7d後的機械通氣狀態、氧閤指數及28 d存活率.結果 與T0比較,俯臥位T1、T2、T3、T4點肺重力依賴區的肺通氣評分均呈下降趨勢,大部分區域俯臥位2h後的肺通氣評分即有明顯改善(P＜0.05),4h後肺通氣評分繼續改善不明顯(P＞0.05);T1、T2、T3、T4的PaO2、PaO2/FiO2均高于T0(P＜0.05),T2的PaO2/FiO2高于T1(t=2.840,P＜0.05),其餘相鄰兩點的PaO2、PaO2/FiO2相比,差異無統計學意義(P＞0.05);俯臥位5d後65例(83.3％)患者氧閤指數＞ 300 mmHg;7d後30例(38.5％)患者可以脫機;28 d死亡率為7例(8.97％).結論 俯臥位通氣2～4h可顯著改善重度ARDS患者肺重力依賴區的通氣狀況,超過4h的俯臥位通氣可能併不能帶來更多的益處.
목적 용폐부초성평고중도급성호흡군박종합정(ARDS)환자부와위통기불동시간점폐통기상황적개변,이학정부와위통기적최가유지시간.방법 수집2012년10월지2014년6월사천성인민의원중증의학과(ICU)수치적78례중도ARDS환자위연구대상,련속행부와위통기5d,매천8h.기록매차부와위즉각(T0)、2 h(T1)、4 h(T2)、6 h(T3)、8 h(T4)적폐통기평분화동맥혈기분석[포괄산감도(pH)치、동맥혈양분압(PaO2)、이양화탄분압(PaCO2)급양합지수(PaO2/FiO2)],관찰환자부와위통기시불량반응、7d후적궤계통기상태、양합지수급28 d존활솔.결과 여T0비교,부와위T1、T2、T3、T4점폐중력의뢰구적폐통기평분균정하강추세,대부분구역부와위2h후적폐통기평분즉유명현개선(P＜0.05),4h후폐통기평분계속개선불명현(P＞0.05);T1、T2、T3、T4적PaO2、PaO2/FiO2균고우T0(P＜0.05),T2적PaO2/FiO2고우T1(t=2.840,P＜0.05),기여상린량점적PaO2、PaO2/FiO2상비,차이무통계학의의(P＞0.05);부와위5d후65례(83.3％)환자양합지수＞ 300 mmHg;7d후30례(38.5％)환자가이탈궤;28 d사망솔위7례(8.97％).결론 부와위통기2～4h가현저개선중도ARDS환자폐중력의뢰구적통기상황,초과4h적부와위통기가능병불능대래경다적익처.
Objective To investigate the ideal persistence time of prone position ventilation in patients with severe acute respiratory distress syndrome (ARDS).Methods Collect 78 cases of severe ARDS admitted to the ICU unit of Sichuan Provincial People's Hospital from October 2012 to June 2014,all the ARDS patients needed to receive 8 h/day prone position continuous 5 day.For each of the prone position ventilation,ultrasound patterns were recorded and the aeration scores were calculated at the beginning of the prone position(T0)and 2 h(T1),4 h(T2),6 h(T3),8 h(T4) later.The correlation of the aeration score variation (ASV) and the arterial blood gas indexes (pH,PaO2,PaCO2,PaO2/FiO2) were recorded also.The adverse reactions,ventilator situation and oxygen fraction after 7 days,28-day mortality were monitored.Results The aeration score of the lung at T1,T2,T3,T4 was significantly reduced than T0 all,the ventilation situation of mainly areas was improved after 2 h PPV (P ＜ 0.05),4 h later it was not distinguished(P ＞ 0.05);the value of PaO2,PaO2/FiO2 was greater at T1,T2,T3,T4 than T0 (P ＜ 0.05),the value of the oxygen fraction was significant increased at T2 than T1 (t =2.840,P ＜ 0.05);the number of patients with oxygen fractions ＞300 mmHg after 5 days PPV was 65(83.3％);there were 30(38.5％) patients free of mechanical ventilation after 7 days;the 28-day mortality was 7 (8.97％).Conclusion In patients with severe ARDS,applicating 2-4 hours validity of prone position ventilation significantly improves the pulmonary ventilation,more than 4 h PPV do not better for patients probably.
