床旁超声导向的最佳呼气末正压对急性呼吸窘迫综合征患者氧合指数及血流动力学的影响

Effects of positive end-expiratory pressure by bedside ultrasound guided on oxygenation index and hemodynamics in patients with acute respiratory distress syndrome

目的探究床旁超声导向的最佳呼气末正压(PEEP)对急性呼吸窘迫综合征患者氧合指数及血流动力学的影响。方法回顾性分析2018年2月至2021年2月本院收治的80例急性呼吸窘迫综合征患者的临床资料,所有患者均接受肺复张处理,以肺复张后PEEP设置方法的不同分为对照组(应用最大氧合法)与观察组(应用床旁超声导向法),每组40例。比较两组最佳PEEP及肺复张前后不同时间氧合指数、动态顺应性水平、血流动力学指标变化情况。结果观察组最佳PEEP高于对照组(P<0.05)。肺复张前,两组氧合指数、动态顺应性水平比较差异无统计学意义;肺复张后15 min、1 h及2 h,两组氧合指数及动态顺应性水平均高于肺复张前,且观察组高于对照组(P<0.05)。肺复张后15 min、1 h后,两组心率(HR)及中心静脉压(CVP)水平均高于肺复张前,平均动脉压(MAP)水平低于肺复张前(P<0.05);肺复张2 h后,两组HR、MAP、CVP水平与肺复张前比较差异无统计学意义;肺复张后15 min、1 h、2 h,两组HR、MAP比较差异无统计学意义;肺复张后15 min、1 h,观察组CVP水平高于对照组,差异有统计学意义(P<0.05),肺复张2 h,两组CVP水平比较差异无统计学意义。结论急性呼吸窘迫综合征患者肺复张后确定PEEP的过程中应用床旁超声导向,可改善患者氧合指数、动态顺应性,减轻对血流动力学造成的影响,值得临床推广应用。

Objective To investigate the effects of positive end-expiratory pressure(PEEP)by bedside ultrasound guided on oxygenation index and hemodynamics in patients with acute respiratory distress syndrome.Methods The clinical data of 80 patients with acute respiratory distress syndrome admitted to our hospital from February 2018 to February 2021 were retrospectively analyzed.All patients received lung recruitment and they were divided into the control group(using maximum oxygen method)and the observation group(using bedside ultrasound guided method)according to the different PEEP setting methods after lung recruitment,with 40 cases in each group,the changes of oxygenation index,dynamic compliance level and hemodynamic index at different time before and after optimal PEEP and lung recruitment were compared between the two groups.Results The optimal PEEP of the observation group was higher than that of the control group(P<0.05).There was no significant difference in oxygenation index and dynamic compliance level between the two groups before lung recruitment.At 15 min,1 h and 2 h after lung recruitment,oxygenation index and dynamic compliance levels in both groups were higher than those before lung recruitment,and the observation group was higher than the control group(P<0.05).After 15 min and 1 h after recruitment,the heart rate(HR)and central venous pressure(CVP)levels of the two groups were higher than those before recruitment,and the mean arterial pressure(MAP)levels was lower than that before recruitment(P<0.05);2 h after lung recruitment,the HR,MAP,and CVP levels between the two groups were not significantly different from those before recruitment;15 min,1 h and 2 h after lung recruitment,there was no statistical difference in HR and MAP between the two groups;15 min and 1 h after lung recruitment,the CVP level in the observation group was higher than that in the control group,and the difference was statistically significant(P<0.05);2 h after lung recruitment,there was no significant difference in CVP levels between the two groups.Conclusion Application of bedside ultrasound guidance in the process of determining PEEP after lung recruitment in patients with acute respiratory distress syndrome can improve oxygenation index,dynamic compliance,and reduce the impact on hemodynamics,which is worthy of clinical application.