ARDS患者呼气末肺容积动态变化及其相关性研究

Dynamic changes of end-expiratory lung volume and its correlation in ARDS patients

目的观察急性呼吸窘迫综合征(acute respiratory distress syndrome,ARDS)患者呼气末肺容积(end expiratory lung volume,EELV)的动态变化及其与氧合指数、顺应性的相关性。方法2018年1月至2021年3月河北医科大学第一医院重症医学科收治的ARDS患者,保留经口气管插管,利用Engstrom呼吸机、采用改良的多重呼吸氮洗脱(NMBW)技术,在呼气末正压(positive end-expiratory pressure,PEEP)为15、10和5 cmH_(2)O以及当前最适宜PEEP条件下,分别在第1、3、5、7天连续测量EELV及氧合指数、顺应性。结果30例患者完成实验,患者氧合指数明显好转(P<0.05)、顺应性呈上升趋势。同一研究时间随PEEP水平升高,EELV逐步增加(P<0.05);不同PEEP水平下,EELV随着时间的推移,EELV成逐步上升趋势(P<0.001)。大部分时间节点,患者的EELV与此时PEEP水平下的顺应性的呈正相关,与氧合指数无相关性。结论ARDS患者EELV明显下降,随病情好转逐步恢复,EELV为肺张力计算提供参考数据,进而指导确定最佳PEEP或通气参数,实现个体化肺保护。

Objective To observe the dynamic changes of end-expiratory lung volume(EELV)and its correlation with oxygenation index and compliance in patients with acute respiratory distress syndrome(ARDS).Methods From January 2018 to March 2021,ARDS patients with orotracheal intubationand treated in the Department of Intensive Care Medicine,The First Hospital of Hebei Medical University were included.We measured EELV using the NMBW technique on days 1,3,5,and 7.EELV measurement was started on the Engstrom Care station respirator at 15,10,and 5 cm H_(2)O and optimal PEEP.The parameters of oxygenation and compliance were measured at the same time.Results 30 patients completed the experiment,and the parameters of oxygenation and compliance improved significantly(P<0.05).Meanwhile,ELVV increased gradually with the increase in PEEP level(P<0.05).Under different PEEP levels,ELVV gradually increased with time.At most time points,the patient′s ELVV was positively correlated with compliance at the PEEP level,but not with oxygenation index.Conclusion The ELVV of ARDS patients decreased significantly,and gradually recovered with the improvement of the condition.ELVV provides reference data for lung tension calculation and then guides the determination of optimal PEEP or ventilation parameters to achieve individualized lung protection.