床旁重症超声对急性呼吸窘迫综合症患者最佳呼气末正压的价值

Value of Bedside Severe Ultrasound in Optimal Positive End-expiratory Pressure in Patients with Acute Respiratory Distress Syndrome

目的探究床旁重症超声对急性呼吸窘迫综合症(ARDS)患者最佳呼气末正压(PEEP)的价值。方法选取2021年5月-2023年5月安福县人民医院重症医学科收治的60例ARDS患者,经随机数字表法分为超声组与对照组,各30例。超声组通过床旁重症超声设定最佳PEEP,在此基础上开展肺复张治疗,对照组则采用最佳氧合法设定最佳PEEP,在此基础上开展肺复张治疗,比较两组氧合指数(PaO2/FiO2)、肺静态顺应性(CLst)、肺动态顺应性(Cdyn)、PEEP、急性生理功能和慢性健康状况评分系统Ⅱ(APACHEⅡ)评分、白细胞计数(WBC)、降钙素原(PCT)、机械通气时间与ICU治疗时间。结果两组肺复张后PaO2/FiO2、CLst、Cdyn指标均高于肺复张前,且超声组PaO2/FiO2、CLst、Cdyn指标高于对照组(P<0.05);两组治疗第3天PEEP指标高于治疗前,APACHEⅡ评分低于治疗前,且超声组PEEP指标高于对照组,APACHEⅡ评分低于对照组(P<0.05);两组治疗第7天WBC、PCT指标低于治疗前,且超声组WBC、PCT指标低于对照组(P<0.05);超声组机械通气时间、ICU治疗时间短于对照组(P<0.05)。结论床旁重症超声可实现ARDS患者肺复张监测,对其最佳PEEP设定具有良好导向作用,可有效改善患者氧合指数,提升其肺顺应性,下调体内炎症指标,缩短患者的机械通气时间与ICU治疗时间。

Objective To explore the value of bedside severe ultrasound on the optimal positive end-expiratory pressure(PEEP)in patients with acute respiratory distress syndrome(ARDS).Methods Sixty patients with ARDS admitted to the Intensive Care Unit,Anfu County People's Hospital from May 2021 to May 2023 were selected and divided into ultrasound group and control group by random number table method,with 30 patients in each group.The optimal PEEP was set by bedside severe ultrasound in the ultrasound group,and the lung recruitment therapy was carried out on this basis.The optimal PEEP was set by the best oxygen method in the control group,and the lung recruitment therapy was carried out on this basis.The oxygenation index(PaO2/FiO2),lung static compliance(CLst),lung dynamic compliance(Cdyn),PEEP,acute physiology and chronic health evaluationⅡ(APACHEⅡ)score,white blood cell count(WBC),procalcitonin(PCT),mechanical ventilation time and ICU treatment time were compared between the two groups.Results The PaO2/FiO2,CLst and Cdyn indexes of the two groups after lung recruitment were higher than those before lung recruitment,and the PaO2/FiO2,CLst and Cdyn indexes of the ultrasound group were higher than those of the control group(P<0.05).On the third day of treatment,the PEEP index of the two groups was higher than that before treatment,the APACHEⅡscore was lower than that before treatment,and the PEEP index of the ultrasound group was higher than that of the control group,the APACHEⅡscore was lower than that of the control group(P<0.05).The WBC and PCT indexes of the two groups on the 7th day of treatment were lower than those before treatment,and the WBC and PCT indexes of the ultrasound group were lower than those of the control group(P<0.05).The mechanical ventilation time and ICU treatment time in the ultrasound group were shorter than those in the control group(P<0.05).Conclusion Bedside severe ultrasound can achieve lung recruitment monitoring in patients with ARDS,and has a good guiding effect on the optimal PEEP setting.Meanwhile,it can effectively improve the oxygenation index of patients,improve their lung compliance,down-regulate the inflammatory indicators in vivo,and shorten the mechanical ventilation time and ICU treatment time of patients.