肺部超声对慢性阻塞性肺疾病急性发作机械通气患者呼气末正压设定的研究

Lung Ultrasound Study set End-Expiratory Pressure in Mechanically Ventilated Patients with Acute Exacerbation of Chronic Obstructive pulmonary Disease

目的探究慢性阻塞性肺疾病急性发作患者在机械通气治疗中,肺部超声对其呼气末正压设定的作用。方法选取该院收治的36例慢性阻塞性肺疾病急性发作患者采用呼气阻断法,测量静态PEEPi,对患者进行相当于内源性呼气末正压水平的20%、30%、40%、60%、80%的外源性呼气末正压水平的施加。在施加结束时对患者肺部超声、气道阻力、气道峰压、气道平台压、呼吸系统顺应性等呼吸指标检测。根据患者对不同外源性呼气末正压水平的反应,比较呼吸指标检测和肺部超声检测设定适当外源性呼气末正压的一致性。结果 36例患者在不同的PEEPe水平间的呼吸系统顺应性差异无统计学意义(P>0.05);气道阻力与总呼吸末正压与PEEPe为0时比较差异有统计学意义(P<0.01);随着PEEPe的增加,超声影像中可见到肺部实变区缩小,液体被挤出肺外,肺周围的液体逐渐增多。患者在不用气压下的呼吸指标与肺部超声影像相一致。结论肺部超声可以作为设定外源性呼气末正压水平的方法。

Objective To investigate the chronic obstructive pulmonary disease with acute exacerbation in patients treated with mechanical ventilation, pulmonary ultrasound its end-expiratory positive pressure setting. Methods Select our hospital, 36 patients with chronic obstructive pulmonary disease with acute exacerbation patients exhale block method, measuring the static PEEPi patients, equivalent to 20% of the endogenous levels of positive end-expiratory pressure, 30%, 40 %, 60%, 80% of the exogenous expiratory PEEP levels applied. Detection of ultrasound applied at the end of the patient’s lungs, airway resistance, peak airway pressure, plateau airway pressure, respiratory system compliance breathing indicators. According to the response of patients with different exogenous levels of positive end-expiratory pressure, more breathing the appropriate exogenous PEEP consistency of the indicators detect lung ultrasound detection setting. Results 36 patients in the between different PEEPe level Respiratory compliance no significant difference（P＆gt;0.05）; airway resistance and total respiratory PEEP PEEPe of 0 There were significant differences（P＆lt;0.01）; With the increase, ultrasound images of the PEPPe to see the the lung consolidation District narrowing gradually increased in the liquid out of the lung, lung fluid surrounding. Patients breathe without Pressure indicators are the lungs Ultrasound consistent. Conclusion Lung ultrasound can be used as the set of exogenous level of positive end-expiratory pressure method.