重症超声在AECOPD机械通气中的应用

Application of Severe Ultrasound in AECOPD Mechanical Ventilation

目的:评估重症超声在慢性阻塞性肺疾病急性加重期(AECOPD)机械通气中的应用价值。方法:选取笔者所在医院2017年2月-2019年3月ICU收治的60例AECOPD患者为研究对象,将其随机分为对照组和研究组,每组30例。对照组通过传统方法测量CVP指导气管插管机械通气后补液治疗,研究组通过重症超声测量下腔静脉扩张指数、膈肌位移(DE)和膈肌收缩速度等指导机械通气后补液治疗。比较两组治疗前后心率、氧合指数(PaO2/FiO2)、脑利钠肽前体(NT-proBNP)水平,拔管时间、不良事件发生率及死亡率。结果:治疗后研究组心率低于对照组,PaO2/FiO2高于对照组,NT-proBNP水平低于对照组,差异均有统计学意义(P<0.05)。研究组拔管时间短于对照组,差异有统计学意义(P<0.05)。研究组重新插管率、呼吸机相关性肺炎(VAP)发生率均低于对照组,差异有统计学意义(P<0.05)。两组死亡率比较差异无统计学意义(P>0.05)。结论:针对AECOPD重症患者,ICU治疗期间采用重症超声指导液体治疗可显著改善患者心功能水平,通过对DE和膈肌收缩速度的观察有效指导拔管,并减少不良事件发生和死亡,建议广泛采用。

Objective:To evaluate the application value of severe ultrasound in mechanical ventilation of acute exacerbation of chronic obstructive pulmonary disease(AECOPD).Method:From February 2017 to March 2019,60 cases of AECOPD patients admitted to ICU of our hospital were selected as research objects,and they were randomly divided into control group and study group,with 30 cases in each group.In the control group,CVP was measured by traditional method to guide rehydration therapy after mechanical ventilation of endotracheal intubation.In the study group,the dilation index of inferior vena cava,diaphragm displacement(DE) and diaphragm contraction velocity were measured by severe ultrasound to guide rehydration therapy after mechanical ventilation.The heart rate,oxygenation index(PaO2/FiO2),brain natriuretic peptide precursor(NT-proBNP) level,extubation time,incidence of adverse events and mortality were compared between the two groups before and after treatment.Result:After treatment,the heart rate of the study group was lower than that of the control group,PaO2/FiO2 was higher than that of the control group,and NT-proBNP level was lower than that of the control group,the differences were statistically significant(P<0.05).The extubation time of the study group was shorter than that of the control group,and the difference was statistically significant(P<0.05).The reintubation rate and the incidence of ventilator-associated pneumonia(VAP) in the study group were lower than those in the control group,the differences were statistically significant(P<0.05).There was no significant difference in mortality between the two groups(P>0.05).Conclusion:For severe patients with AECOPD,the use of severe ultrasound-guided fluid therapy during ICU treatment can significantly improve the level of cardiac function of patients.The observation of DE and diaphragm contraction velocity can effectively guide extubation,and reduces adverse events and death,which is recommended to be widely adopted.