EIT监测ARDS脱机困难患者早期活动过程中肺部通气变化

Study on monitoring lung ventilation during early mobilization in ARDS patients with difficulty of weaning from mechanical ventilation based on electrical impedance tomography technology

目的观察电阻抗断层成像术(EIT)监测急性呼吸窘迫综合征(ARDS)脱机困难患者早期活动过程中肺部通气变化。方法选取2020年6月至8月入住北京协和医院ICU需进行早期活动的20例ARDS脱机困难患者,根据其早期活动过程中血氧饱和度(SpO_(2))变化情况,将其分为改善组(SpO_(2)改善,10例)及未改善组(SpO_(2)无变化或下降,10例)。应用EIT监测患者的肺部通气,记录其一般资料及其SpO_(2),针对其对肺部划分的平行的ROI1~4区(ROI1,ROI2,ROI3,ROI4),记录其早期活动前、早期活动30 min、早期活动60 min、早期活动结束后的区域通气比例。结果改善组早期活动30 min[(97.0±1.4)%]及60 min[(97.1±1.5)%]的SpO_(2)明显改善,与早期活动前[(94.1±2.6)%]比较,差异均有统计学意义(t=5.117,P<0.01;t=3.557,P<0.01),同时EIT显示,早期活动30 min[(9.3±6.1)%]及60 min[(10.8±7.2)%]的ROI4区通气状况明显改善,与早期活动前[(4.8±2.7)%]比较,差异有统计学意义(t=2.942,P=0.016;t=2.905,P=0.017)。未改善组早期活动30 min[(97.0±1.7)%]及60 min[(97.1±1.4)%]SpO_(2)下降,与早期活动前[(98.4±1.6)%]比较,差异均有统计学意义(t=8.573,P<0.01;t=4.333,P=0.020),同时EIT显示,仅ROI4区早期活动30 min[(7.6±3.4)%]与早期活动前[(10.3±4.0)%]比较,差异有统计学意义(t=3.199,P=0.011),其他各区早期活动30 min及60 min通气均无明显改善,差异均无统计学意义(P>0.05)。结论EIT可以监测和评估重症ARDS脱机困难患者早期活动过程中肺部的通气情况。

Objective To observe the changes in pulmonary ventilation during early mobilization in ARDS patients with difficulty of weaning from mechanical ventilation under electrical impedance tomography(EIT).Methods Twenty ARDS patients with difficulty of weaning from mechanical ventilation admitted to ICU from June to August 2020 who required early mobilization were selected and divided into an improved group(oxygen saturation improved after early mobilization,10 cases)and a non-improved group(oxygen saturation did not improve after early mobilization,10 cases)according to their oxygen saturation changes.The EIT was used to monitor the patient's lung ventilation,record the proportion of regional ventilation before,at 30 min,at 60 min,and at the end of early mobilization,for the four parallel ROI zones(ROI1,ROI2,ROI3,and ROI4)which they had divided their lungs.Results Oxygen saturation at 30 min[(97.0±1.4)%]and 60 min[(97.1±1.5)%]of early mobilization was significantly improved in the improved group,with statistically significant differences(t=5.117,P<0.01;t=3.557,P<0.01),compared to pre-early mobilization[(94.1±2.6)%].In addition,EIT monitored a statistically significant improvement in ventilation in ROI 4 zone at 30 min[(9.3±6.1)%]and 60 min[(10.8±7.2)%]of early mobilization,compared with pre-early mobilization[(4.8±2.7)%](t=2.942,P=0.016;t=2.905,P=0.017).Oxygen saturation decreased in the non-improved group at 30 min[(97.0±1.7)%]and 60 min[(97.1±1.4)%]of early mobilization,compared to[(98.4±1.6)%]pre-early mobilization,with statistically significant differences(t=8.574,P<0.01;t=4.333,P=0.020).The EIT also showed a statistically significant difference(t=3.199,P=0.011)in only ROI4 zone 30 min[(7.6±3.4)%]compared to pre-early mobilization[(10.3±4.0)%],with no significant improvement in 30 min and 60 min ventilation in all other zones(P>0.05).Conclusion The EIT can be used in monitoring and assessing of lung ventilation during early mobilization in patients with severe ARDS having difficulty in weaning from mechanical ventilation.