电阻抗断层显像技术在急性呼吸窘迫综合征患者设定呼气末正压中的临床应用

Application of electrical impedance tomography on positive end-expiratory pressure setting in patients with acute respiratory distress syndrome

目的 探讨电阻抗断层显像技术(electrical impedance tomography,EIT)在急性呼吸窘迫综合征(acute respiratory distress syndrome,ARDS)患者中个体化调节呼气末正压(positive end-expiratory pressure,PEEP)的应用价值。方法 选取2019年4月—2022年3月间收治的需机械通气治疗的ARDS患者为研究对象,随机分为三组,每组各12例。分别使用ARDSnet法(对照组)、肺部超声评分法(lung ultrasound scoring,LUS)(LUS组)和EIT调整法(EIT组)设置最佳PEEP,并记录各时间点患者的血流动力学、血气分析、呼吸力学、血管外肺水指数等指标变化。结果 EIT组和LUS组PEEP值比较差异无统计学意义,但显著高于对照组(P<0.05)。治疗12 h后对照组的动态肺顺应性无明显变化,而LUS组和EIT组的动态肺顺应性有显著改善,且EIT组改善明显优于对照组(P<0.05)。三组患者治疗后氧合指数均有显著升高,且EIT组氧合指数明显高于对照组(P<0.05)。治疗前后三组血流动力学比较无明显差异(P>0.05)。三组患者治疗后的血管外肺水指数均显著降低,且LUS组和EIT组较对照组降低更显著(P<0.05)。结论 在ARDS患者的PEEP设置中,运用EIT个性化调整法可有效改善患者肺顺应性及氧合指数,降低血管外肺水,并不对血流动力学造成影响。

Objective To explore the clinical application value of electrical impedance tomography(EIT) individualized adjustment of positive end-expiratory pressure(PEEP) in patients with acute respiratory distress syndrome(ARDS).Methods The ARDS patients requiring mechanical ventilation who admitted between April 2019 and March2022 were recruited in the study.They were randomly divided into 3 groups with 12 cases in each group.Optimal PEEP was set using ARDSnet method(a control group),lung ultrasound scoring method(LUS group) and EIT adjustment method(EIT group).The changes of hemodynamics,blood gas analysis,respiratory mechanics,extravascular lung water index and other indicators of the patients were recorded at each time point.Results There was no significant difference in PEEP between the EIT group and the LUS group,but PEEP in both the EIT group and the LUS group was significantly higher than the control group(P<0.05).After 12 hours of treatment,the dynamic lung compliance of the control group did not change significantly,while the dynamic lung compliance ventilation of the LUS group and the EIT group was significantly improved for 12 hours,and the improvement in the EIT group was significantly better than that in the control group(P<0.05).After treatment,the oxygenation index in the three groups was significantly increased,and the oxygenation index in the EIT group was significantly higher than that in the control group(P<0.05).There was no significant difference in hemodynamics between the three groups before and after treatment(P>0.05).The extravascular lung water index of the three groups after treatment was significantly decreased,and the LUS group and the EIT group decreased more significantly than the control group(P<0.05).Conclusion In the PEEP setting of ARDS patients,the use of EIT personalized adjustment method can effectively improve the patient's lung compliance and oxygenation index,and reduce extravascular lung water,without affecting hemodynamics.