通过电阻抗断层成像技术观察体位对机械通气ARDS患者肺通气的影响

Through the electrical impedance tomography technology(EIT) to observe the position of the effects of mechanical ventilation in patients with ARDS lung ventilation

目的利用电阻抗断层成像技术(electrical impedance tomography,EIT)观测急性呼吸窘迫综合征(acute respiratory distress syndrome,ARDS)患者机械通气时,在不同体位下患者的肺内气体分布情况,并观察氧分压、氧合指数、潮气量的变化情况。方法采用前瞻性随机对照研究方法,选择首都医科大学附属北京潞河医院急诊重症监护病房2015年1月至2017年6月收治行机械通气的ARDS患者作为研究对象,应用随机数字表法分为试验组和对照组。试验组设定为常规体位有效抬高30°的基础上,每日间断予患者采取90°端坐位8 h;对照组设定为体位持续抬高30°。比较2组患者入组时、体位有效保持72、96、120 h后,分别通过EIT收集2组患者的感兴趣区域(region of interest,ROI)值,同时收集患者潮气量、通过血气分析收集氧分压、氧合指数等参数,以及呼吸机使用时间和监护室住院时间。结果研究期间最终共60例患者纳入分析,其中试验组27例,对照组33例。2组患者性别、年龄、急性生理和慢性健康评分Ⅱ(acute physiology and chronic health evaluationⅡ,APACHEⅡ)评分以及导致ARDS的病因等比较差异无统计学意义。与对照组相比,试验组患者在体位有效保持96 h及120 h后Pa O2及氧合指数明显高于对照组,2组比较差异均有统计学意义(P<0.05),同时通过EIT观测试验组患者肺重力依赖区96 h及120 h ROI3值、ROI4值明显高于对照组,差异均有统计学意义(P<0.05),试验组患者呼吸机使用时间及监护室住院时间明显低于对照组,差异有统计学意义(P<0.05),试验组与对照组患者在体位有效保持96 h及120 h后潮气量值差异无统计学意义(P>0.05),试验组与对照组患者体位有效保持72 h时比较,氧分压、氧合指数、潮气量差异无统计学意义(P>0.05)。结论对于ARDS患者行机械通气期间,每日间断予患者采取90°端坐位8 h以上,在96 h后,能够有效改善重力依赖区的肺通气情况,有效改善患者的氧分压及氧合指数,促进患者早日成功脱机拔管。

Objective To use electrical impedance tomography technology（EIT） to observe acute respiratory distress syndrome（ARDS） patients with mechanical ventilation,in the distribution of gas in the lungs of patients with different position,and to observe the oxygen partial pressure,oxygenation index,changes of the tidal volume.Methods The prospective randomized study method will be used,the patients with ARDS in the Emergency Intensive Care Unit,Beijing Luhe Hospital,Capital Medical University in January 2015 to June 2017 were tested with lines of mechanical ventilation as the research objects,and vis application of random grouping method,the tests were divided into trial group and control group.Experimental group will be set to normal position effectively to raise 30 degrees,on the basis of daily 8 hours continuously to patients with 90 degrees of sitting position.The control group was set up 30 degrees continuously for the position.The two groups of patients were compared,position effectively maintains 72,96,120 hours,respectively which were collected by electrical impedance imaging region of interest（ROI） values of two groups of patients,patients which were collected through breathing machine tidal volume,through the blood gas analysis to collect oxygen partial pressure,oxygenation index parameters,such as breathing machine and use time and care in the hospital.Results Finally,a total of 60 patients were included in the analysis of 27 casesof test group and control group 33 cases.Two groups of patients with gender,age,acute physiology and chronic health evaluation Ⅱ（APACHEⅡ） scores and lead to the causes of ARDS was no statistically significant difference.Compared with the control group,experimental group patients in position effectively maintain 96 hours and 120 hours after PaO_2 and oxygenation index was significantly higher than the control group,differences were statistically significant（P0.05）,at the same time,through the observation of EIT technology experimental group patients gravity ROI3 values depend on the area for 96 hours and 120 hours,ROI4 value was significantly higher than the control group（P0.05）.Patients in the experimental group were significantly lower in ventilator use time and in the hospital than in the control group（P0.05）;the experimental group compared with the control group in position effectively maintain 96 hours and 120 hours after,tidal volume no significant change（P0.05）.Position effectively maintain 72 hours,the experimental group compared with the control group patients of oxygen partial pressure,oxygenation index,tidal volume,the difference were statistically significant（P0.05）.Conclusion For patients with ARDS line during invasive ventilation,daily continuously to 90 degrees patients keep sitting more than 8 hours,after 96 hours,can effectively improve the gravity depend on the changes of pulmonary ventilation,effectively improve the patient＇s oxygen partial pressure and oxygenation index,promote patients of pulmonary rehabilitation,promote patients successfully weaning tube drawing at an early date.