呼吸波形监测在急诊科危重病早期诊治中的应用

Application of respiratory waveform monitoring to critical patients in the early diagnosis and treatment

目的 探讨呼吸波形监测在急诊科危重病早期诊治中的临床意义.方法 总结我院急诊科使用呼吸机通气患者100例次.在不影响临床治疗前提下,将患者根据使用呼吸机原因分为无自主呼吸组、限制性通气障碍组、阻塞性通气障碍组、呼吸道分泌物（痰液）蓄积组和异常呼吸运动组五组,分别观察五组患者在治疗过程中的呼吸波形变化.对所出现的特征性图形和数据进行记录并进行统计学处理.结果 常见急危重病在呼吸波形上可形成＂鸭嘴＂状、＂鸟嘴＂状、＂火炬＂状、＂海棠叶＂状、＂柳树叶＂状、＂钝角三角形＂状、＂锯齿＂状、＂波纹＂状、＂8＂字状等带有形象特征的异常呼吸波形图像.这些异常呼吸波形与气道阻力、流量和流速等参数有显著相关性.不同疾病可出现带有不同特征的异常呼吸波形.结论 应用呼吸波形监测技术有助于对急危重病的早期、快速诊断和抢救治疗,这对提高急危重病早期急救质量有重要的临床指导意义.

Objective To investigate the clinical significance of respiratory waveform monitoring for critical patients of emergency department in early diagnosis and treatment, to study relationship between critical illness and respiratory waveform and to confirm characteristic image of respiratory waveform in order to provide clinical basis for early diagnosis and treatment. Methods 100 patients with ventilator in our emergency department were chosen. Without affecting the clinical treatment, the patients were divided into no spontaneous breathing group, restrictive ventilation group, obstructive ventilatory group, accumulated respiratory secretions （sputum） group and the abnormal breathing exercise group. Respiratory pattern changes were observed in the five groups during treatment. Characteristic graphs and data were recorded and statistically analyzed. Results ＂Duckbill＂, ＂beak＂, ＂torch＂, ＂Begonia Leaf＂, ＇＂ willow leaf＂, ＂＇ an obtuse triangle＂, ＂sawtooth＂, ＂＇ corrugated＂, and＂ 8＂ shape with the typical characteristics of abnormal respiratory pattern images could be formed in the respiratory pattern of the common acute and critical illness. There apparent correlations between these abnormal respiratory pattern and airway resistance, flow and velocity parameters. Different diseases showed different respiratory pattern. Conclusion There are apparent correlations between these abnormal respiratory patterns and their corresponding critical illness. It is helpful for early, rapid diagnosis and emergency treatment in critical patients; There are important clinical significances in improving the quality of acute critical illness.