A Deep Learning-Based Continuous Blood Pressure Measurement by Dual Photoplethysmography Signals

This study proposed a measurement platform for continuous blood pressure estimation based on dual photoplethysmography(PPG)sensors and a deep learning(DL)that can be used for continuous and rapid measurement of blood pressure and analysis of cardiovascular-related indicators.The proposed platform measured the signal changes in PPG and converted them into physiological indicators,such as pulse transit time(PTT),pulse wave velocity(PWV),perfusion index(PI)and heart rate(HR);these indicators were then fed into the DL to calculate blood pressure.The hardware of the experiment comprised 2 PPG components(i.e.,Raspberry Pi 3 Model B and analog-todigital converter[MCP3008]),which were connected using a serial peripheral interface.The DL algorithm converted the stable dual PPG signals acquired from the strictly standardized experimental process into various physiological indicators as input parameters and finally obtained the systolic blood pressure(SBP),diastolic blood pressure(DBP)and mean arterial pressure(MAP).To increase the robustness of the DL model,this study input data of 100 Asian participants into the training database,including those with and without cardiovascular disease,each with a proportion of approximately 50%.The experimental results revealed that the mean absolute error and standard deviation of SBP was 0.17±0.46 mmHg.The mean absolute error and standard deviation of DBP was 0.27±0.52 mmHg.The mean absolute error and standard deviation of MAP was 0.16±0.40 mmHg.

Changes in Brachial and Central Blood Pressure after Short Term Continuous Positive Airway Pressure Treatment of Patients with Moderate-to-Severe Obstructive Sleep Apnoea and Impaired Renal Function

Background: Previous studies of continuous positive airway pressure (CPAP) treatment for obstructive sleep apnoea (OSA) have shown conflicting results on the effect on blood pressure (BP), and patients with chronic kidney disease (CKD) have not been included in these studies. As OSA is a frequent comorbidity in patients with CKD, it is of relevance to evaluate the effect of CPAP treatment on BP in this population. Aim: In this prospective follow-up study, we measured the effect of short term CPAP treatment of moderate-to-severe OSA on brachial and central BP, plasma level of syndecan-1 and vasoactive hormones, renal handling of sodium, subjective sleepiness, and quality of life in patients with impaired renal function. Methods: From December 2015 until March 2017, 25 patients were invited to participate in the study at the University Clinic in Nephrology and Hypertension, Aarhus University and Holstebro Hospital. At baseline and at follow-up after three to four months of CPAP treatment, we performed 24 h brachial and central ambulatory BP measurement, blood sampling measurements of plasma concentrations of syndecan-1, renin, angiotensin II, aldosterone, vasopressin, creatinine, haemoglobin A1c, and cholesterol, cardio respiratory monitoring, 24 h urine collection for measurement of urinary excretion of albumin, aquaporin-2, and epithelial sodium channel, Epworth Sleepiness Scale (ESS), and SF-36 (quality of life). Results: At follow-up, the 17 included patients with mean baseline estimated glomerular filtration rate 66 mL/min/1.73 m2 had a significant decrease in systolic office-, 24 h- and daytime-BP (13, 7, and 8 mmHg, respectively, p Conclusion: Short-term CPAP treatment of patients with moderate-to-severe OSA and reduced renal function decreased 24 h- and daytime-BP significantly and reduced urinary albumin excretion. Our results underline the importance of treatment of OSA in hypertensive patients with impaired renal function.

Effects of Continuous Non-Invasive Blood Pressure Monitoring on Intraoperative Hemodynamics and Postoperative Myocardial Injury in Craniotomy:Comparison Between Groups Based on Self-Control and Propensity Score Matching

Objective:To explore the effect of continuous non-invasive blood pressure monitoring on intraoperative hemodynamics and postoperative myocardial injury in craniotomy.Methods:120 cases of elective craniotomy were divided into the self-control group(continuous non-invasive blood pressure monitoring and intermittent cuff non-invasive blood pressure monitoring,CNAP group)and propensity score matching group(only intermittent cuff non-invasive blood pressure measurement in previous craniotomy,PSM group);Goal-directed hemodynamic management in CNAP group included heart rate(HR),blood pressure(BP),stroke volume(SV),stroke variability(SVV),and systemic vascular resistance index(SVRI).The main index is to compare the troponin level within 72 hours after operation between the CNAP group and the PSM group;The secondary indicators are the comparison of the hemodynamic conditions between the CNAP group and the PSM at 10 specific time points.Results:The incidence of postoperative myocardial injury in the CNAP group was significantly lower than that in the PSM group(12%vs.30%,P=0.01);in the CNAP group hypotensive episodes(6 vs.3,P=0.01),positive balance of fluid therapy(700 vs.500 mL,P<0.001),more use of vasoactive drugs(29 vs.18,P=0.04),more stable hemodynamics medical status(P=0.03)were recorded.Conclusion:The hemodynamic management strategy based on continuous non-invasive blood pressure monitoring can reduce the incidence of myocardial injury after elective craniotomy and maintain a more stable hemodynamic state.

Evaluation of the Distribution and Factors Affecting Blood Pressure Using Medical Checkup Data in Japan

In this paper, we first evaluated the distribution of blood pressure (BP) using a dataset containing 113,979 measurements in 48,022 individuals with the cooperation of one health insurance society in Japan from April, 2013 to March, 2016. The means of the systolic BP (SBP) and diastolic BP (DBP) were 125.4 and 77.6 mmHg with standard deviations of 16.5 and 11.7 mmHg, respectively. Under the 140/90 criterion, 21.6% of the measurements showed hypertension. According to the World Health Organization/International Society of Hypertension criterion, 16.4%, 4.2% and 0.96% were classified as grades 1, 2 and 3, respectively. The factors affecting BP were evaluated by a regression analysis and were found to include age, gender, some eating habits, daily activities, smoking, drinking alcohol, sleeping and wages. Age was a very important factor, and the age cohorts from the previous study might be revised based on these findings. Among factors that individuals can control, the influence of drinking alcohol is very large. Comparing to an individual who does not drink, SBP and DBP of a heavy drinker are more than 5.0 mmHg higher on the average.

Changes in Plasma Angiotensin II and Circadian Rhythm of Blood Pressure in Hypertensive Patients with Sleep Apnea Syndrome Before and After Treatment

Objective To explore the changes in plasma angiotensin II （Ang Ⅱ） and circadian rhythm of blood pressure among hypertensive patients with sleep apnea syndrome （SAS） before and after continuous positive airway pressure （CPAP） or surgical treatment. Methods A total of 180 essential hypertension patients were enrolled in our study. The determination of plasma Ang Ⅱ concentration, ambulatory blood pressure （ABP）, and polysomnography （PSG） monitoring were performed before and 3 months after CPAP or surgical treatment. Results Patients were classified into three groups by their apnea-hypopnea index （AHI）： essential hypertension group （EH group, n=72; AHI〈5）, essential hypertension with mild SAS group （EH＋mild SAS group, n=60, 5≤AHI〈20）, and essential hypertension with moderate and severe SAS group （EH＋moderate-severe SAS group, n=48, AHI_〉20）. The concentrations of plasma AngⅡ in the above three groups were 13.42±3.27, 16.17±3.82, and 18.73±4.05 ng/mL respectively before treatment, and AngⅡ concentration in EH patients combined with SAS was significantly higher than that in EH group （all P〈0.05）. After treatment the values in the latter two groups significantly decreased to 14.67±2.56 and 15.03±3.41 ng/mL respectively （P〈0.05）. The incidence of non-dipper blood pressure curve in EH patients was 31.9%, and those in hypertensive patients with mild SAS and moderate-severe SAS were 51.7% and 58.3%, respectively before treatment. The incidence of non-dipper blood pressure curve in the EH patients with mild SAS was significantly higher than that of patients with EH alone （P〈0.05）. After CPAP treatment or surgery, the incidence of non-dipper blood pressure curve in the two SAS groups was significantly decreased to 38.3% and 39.6%, respectively （P〈0.05）. Conclusions Ang Ⅱ might play a role in blood pressure variability in patients with obstructive SAS. CPAP or surgical treatment can improve blood pressure disorder and decrease plasma Ang Ⅱ level in patients with obstructive SAS.

Noncontact Monitoring of Relative Changes in Blood Pressure Using Microwave Radar Sensors

This study aims to confirm whether noncontact monitoring of relative changes in blood pressure can be estimated using microwave radar sensors. First, an equation to estimate blood pressure was derived, after which, the effectiveness of the estimation equation was confirmed using data obtained by a noncontact method while inducing variations in blood pressure. We considered that the Bramwell-Hill equation, which contains some parameters that directly indicate changes in blood pressure, would be an appropriate reference to construct an estimation equation for the noncontact method, because measurements using microwave radar sensors can measure minute scale motion on the skin surface induced by the pulsation of blood vessels. In order to estimate relative changes in blood pressure, we considered a simple equation including the pulse transit time (PTT), amplitude of signals and body dimensions as parameters. To verify the effectiveness of the equation for estimating changes in blood pressure, two experiments were conducted: a cycling task using an ergometer, which induces blood pressure fluctuations because of changes in cardiac output, and a task using the Valsalva maneuver, which induces blood pressure fluctuations because of changes in vascular resistance. The results obtained from the two experiments suggested that the proposed equation using microwave radar sensors can accurately estimate relative changes of blood pressure. In particular, relatively favorable results were obtained for the changes in blood pressure induced by the changes in cardiac volume. Although many issues remain, this method could be expected to contribute to the continuous evaluation of cardiac function while reducing the burden on patients.

Mechanism of Magnetic Pulse Wave Signal for Blood Pressure Measurement

Continuous non-invasive blood pressure (BP) measurement can be realized by using pulse transit time (PTT) based on electrocardiogram (ECG) and pulse wave signal. Modulated magnetic signature of blood (MMSB) is a promising approach to obtain PTT. The origin of MMSB is critical to establish the relationship between MMSB and BP. In this paper, two possible origins of MMSB, blood disturbance mechanism and angular variation mechanism, are analyzed and verified through three control experi-ments under different conditions. The influence of blood velocity alteration and blood volume alteration on magnetic field is investigated though blood flow simulation sys-tem. It is found that MMSB comes mainly from the periodic blood flow while the per-turbation caused by angular variation between sensitive axis of the magnetic sensor and geomagnetic field can be neglected. As to blood disturbance mechanism, the change of blood volume plays a decisive role while the effect of blood velocity altera-tion is negligible.

nCPAP治疗对OSAHS合并EMBPS高血压患者血压的影响

目的观察经鼻持续气道正压通气(nCPAP)治疗对中重度阻塞型睡眠呼吸暂停低通气综合征(OSAHS)合并血压晨峰(EMBPS)的高血压患者EMBPS水平的影响。方法通过多导睡眠图(PSG)和24h动态血压监测(AB-PM)入选中重度OSAHS合并EMBPS的高血压患者34例,其中治疗组20例,对照组14例。计算血压晨峰的平均收缩压(AvSP)、平均舒张压(AvDP)、平均动脉压(MABP)。治疗组连续5晚使用nCPAP治疗。所有研究对象均于实验第5日再次行ABPM检测以上指标。比较两组在观察前后血压的差别。结果治疗组治疗后血压晨峰AvSP(30.03±7.77mmHg)、血压晨峰MABP(24.61±8.19 mmHg)较治疗前(35.96±5.18、29.18±6.76 mmHg)下降,差异有统计学意义(P<0.05)。结论 OSAHS可能是高血压EMBPS的促成因素之一。对合并高血压的中重度OSAHS患者进行nCPAP治疗具有重要意义。对于药物控制不理想的此类临床患者,可进行PSG检查,筛查OSAHS,并对中重度患者进行nCPAP治疗。

基于BP神经网络的无创连续血压测量模型

目的通过采集人体脉搏波信号和动脉血压值,建立基于BP神经网络的无创连续血压测量模型。方法将脉搏波信号进行预处理,计算其特征参数并筛选出相关性较高的特征参数,利用BP神经网络建立无创血压测量模型。结果收缩压、舒张压的仿真值和测得值的均方根误差分别为5.92、6.11 mmHg(1 mmHg=0.133 kPa)。结论该模型的仿真值对临床上血压连续测量具有一定的参考意义。

低容量高强度间歇训练对肥胖或超重人群心血管疾病风险因子影响的Meta分析

目的:通过Meta分析综合定量评价低容量高强度间歇训练对预防肥胖或超重人群心血管疾病的效果,进一步验证低容量高强度间歇训练在肥胖等特殊人群中应用的可行性。方法:在中国知网、PubMed、Web of Science、Cochrane Library和EBSCO-SPORTD运动科学全文数据库检索关于低容量高强度间歇训练相关研究的随机对照试验文献,检索时限为各数据库建库至2024年2月。由2名研究人员对所纳入的研究进行筛选、质量评价和数据提取,采用RevMan 5.4和Stata 17.0软件对结局指标进行Meta分析,包括合并效应量、亚组分析、Leave-One-Out敏感性分析以及发表Egger检验和绘制漏斗图。该方案已在国际系统综述前瞻性注册中心注册(CRD42024534409)。结果:①最终筛选纳入符合要求的13项随机对照试验,共包含349例受试者,纳入文献整体质量较高。②低容量高强度间歇训练干预对心肺适能(SMD=-0.65,95%CI:-0.87至-0.43,P<0.05)、收缩压(SMD=0.38,95%CI:0.11-0.65,P<0.05)、舒张压(SMD=0.42,95%CI:0.15-0.68,P<0.05)和体脂百分比(SMD=0.25,95%CI:0.02-0.49,P<0.05)4项指标具有改善效果。③低容量高强度间歇训练与中等强度持续训练相比在改善超重或肥胖人群心肺适能、收缩压、舒张压、体脂百分比、标准体质量、体质量指数、高密度脂蛋白、低密度脂蛋白和总胆固醇指标方面干预效果相似(P>0.05),但在改善三酰甘油效果方面中等强度持续训练优于低容量高强度间歇训练(SMD=-0.30,95%CI:-0.57至-0.02,P<0.05)。④亚组分析结果进一步显示,低容量高强度间歇训练和中等强度持续训练干预对各项指标的改善效果相似。结论:当前证据表明,低容量高强度间歇训练可以有效提升超重或肥胖人群的心肺适应能力以及促进减脂和血压调控,且改善效果与中等强度持续训练相似。短时间的低容量高强度间歇训练相比于长时间的中等强度持续训练更具有时间效益。建议未来通过更多研究确定适用于超重或肥胖人群最佳的低容量高强度间歇训练运动处方。

基于BP神经网络的血压监测算法

针对目前血压监测算法存在的不足,提出一种基于BP神经网络的血压监测算法。对光电容积脉搏波(PPG)、加速脉搏波(APG)及血压数据进行特征提取,得到10维输入向量和2维输出向量,将以上参数输入到BP神经网络中进行训练,得到血压监测算法模型的输出结果。经过计算平均绝对误差(MAE)、均方根误差(RMSE)以及通过线性回归分析评估该算法,评估结果表明,该算法具有良好的血压监测效果。此外,基于脉搏传感器MAX30102及STM32单片机设计硬件电路,采集测试者的脉搏波数据,并结合提出的算法进行实验。实验结果表明,该算法对收缩压和舒张压检测的误差分别为1.205±0.865 mmHg和1.3±0.5 mmHg,标准差分别为1.255±0.825 mmHg和1.465±0.515mmHg,符合AAMI血压测量标准,对血压实时监测具有较好的应用价值。

基于GA优化的MIV-BP神经网络连续血压无创监测方法研究

针对现有的基于脉搏波传导时间法或脉搏波特征参数法的血压测量模型存在的不足,提出利用平均影响值(Mean Impact Value,MIV)法从提取的脉搏波传导时间和脉搏波特征参数中优选出对血压值影响较大的参数作为输入量,血压值作为输出量训练BP神经网络模型,然后采用遗传算法(Genetic Algorithm,GA)对个性化参数进行优化,从而建立一种连续血压无创监测模型—GA-MIV-BP神经网络模型。该模型计算血压的结果与实际测量得到的结果进行Bland-Altman一致性分析,表明两者具有很好的一致性,可互换使用,因此该算法对促进无创连续血压监测方法的临床应用具有积极作用。

基于小波分析与BP神经网络的人体血压预测

及时、准确预测人体血压变化从而预防人体血压不稳定导致的病情加重的情况发生显得越来越重要.对此本文提出一种基于小波分析与BP神经网络组合的人体血压预测模型,该模型利用小波分解重构法对非平稳的人体血压序列进行分解重构计算,分离出原始序列中的高频细节分量和低频趋势分量,再利用BP神经网络预测算法对各层分量建立预测模型,最后将两种模型的预测值进行叠加,得到原始血压序列的预测值.研究表明,该组合预测模型的预测精度明显高于传统BP神经网络预测模型的预测精度,为人体血压预测提供了一种有效可靠的组合预测方法.

基于BP神经网络的脉搏触压觉与血压关系分析

本研究旨在探究脉搏触压觉与血压之间的关系,自制的脉搏图像采集系统获得触压觉参数的同时,通过袖带法得到动脉血压值,并进行二者关系预测。首先在不同切脉压力下,采集探头的薄膜搏动视频图像,并从中提取脉搏信号的脉幅最大值、重心频率、功率谱密度最大值等时频域特征。然后采用反向传播神经网络对动脉血压的舒张压和收缩压进行分析。实验结果表明通过以上特征参数可以较准确地预测出血压值。

基于卷积神经网络-长短期记忆神经网络模型利用光学体积描记术重建动脉血压波信号

目的直接动脉血压(arterial blood pressure,ABP)连续监测是侵入式的,传统袖带式的间接血压测量法无法实现连续监测。既往利用光学体积描记术(photoplethysmography,PPG)实现了连续无创血压监测,但其为收缩压和舒张压的离散值,而非ABP波的连续值,本研究期望基于卷积神经网络-长短期记忆神经网络(CNN-LSTM)利用PPG信号波重建ABP波信号,实现连续无创血压监测。方法构建CNN-LSTM混合神经网络模型,利用重症监护医学信息集(medical information mart for intensive care,MIMIC)中的PPG与ABP波同步记录信号数据,将PPG信号波经预处理降噪、归一化、滑窗分割后输入该模型,重建与之同步对应的ABP波信号。结果使用窗口长度312的CNN-LSTM神经网络时,重建ABP值与实际ABP值间误差最小,平均绝对误差(mean absolute error,MAE)和均方根误差(root mean square error,RMSE)分别为2.79 mmHg和4.24 mmHg,余弦相似度最大,重建ABP值与实际ABP值一致性和相关性情况良好,符合美国医疗器械促进协会(Association for the Advancement of Medical Instrumentation,AAMI)标准。结论CNN-LSTM混合神经网络可利用PPG信号波重建ABP波信号,实现连续无创血压监测。

一款无创连续血压测量设备研制及其准确性验证

目的:研制一款无创连续血压测量设备NC-BPM型并验证其监测血压的准确性。方法:研制一款NC-BPM型无创连续血压测量设备(简称NC-BPM),整套设备系统主要由指套传感器、信号采集和压力控制单元、高度校正系统和主机4个模块组成。使用欧姆龙J760电子血压计(简称J760)和CNAP Monitor 500连续无创血压监测系统(简称CNAP Monitor 500)作为监测血压准确性验证的参考血压计,按照美国电气和电子工程师协会(IEEE)有关可穿戴无袖带血压测量装备标准测试流程,分别测量25名受试者静态期、血压变化期和校准后期3个阶段的血压,验证NC-BPM测量血压的准确性。结果:使用NCBPM与CNAP Monitor 500均采集到13753个数据点,两种仪器测得收缩压(SBP)、舒张压(DBP)及平均血压(MAP)具有高度相关性(r=0.96、0.97、0.98,P<0.05);欧姆龙J760采集到379个数据点,NC-BPM与欧姆龙J760测得SBP和DBP数据亦有高度相关性(r=0.98、0.95,P<0.05)。按照英国高血压协会(BHS)和美国医疗仪器促进协会(AAMI)标准的等级评价,NCBPM与CNAP Monitor500的SBP差值在0~5 mmHg、0~10 mmHg和0~15 mmHg范围内的占比分别为85.01%、97.60%和99.47%,DBP占比分别为84.34%、99.85%和100%,MAP占比分别为92.66%、99.72%和99.96%,三者均属BHS标准A级;两种仪器测量的指动脉SBP、DBP和MAP压差值分别为(0.67±5.07)mmHg、(2.43±2.87)mmHg和(1.43±2.89)mmHg,均在AAMI标准(5±8)mmHg范围内。NC-BPM与欧姆龙J760的SBP差值0~5 mmHg、0~10 mmHg和0~15 mmHg范围内占比分别为79.95%、97.36%和100%,DBP占比分别为89.71%、99.74%和100%,两者均属BHS标准A级;两种仪器测量的肱动脉收缩压、舒张压差值分别为(1.57±4.18)mmHg、(0.57±5.20)mmHg,均在AAMI标准(5±8)mmHg范围内。结论:NC-BPM设备已通过了IEEE标准下AAMI标准的第一阶段临床试验,可进行下一阶段临床验证试验。

基于脉搏波和心电信号的无创连续血压预测方法研究

目的 研究基于脉搏波和心电信号的无创连续血压预测方法。方法 从MIMIC-Ⅲ数据库中选取300个病例,用于构建血压预测模型、模型验证;另收集2022年1月至6月入住福建省立医院重症监护病房的121例患者,用于测试模型;采集患者动脉血压、光电容积脉搏波和心电图信号。构建两个血压预测模型,一个是以人工提取出的8种特征参数构建的人工特征参数模型,另一个是以8种特征参数加1种卷积神经网络提取的特征进行融合构建的特征融合模型。对两个预测模型进行验证、测试,评价指标采用平均绝对误差(MAE)、标准差(SD)、均方根误差(RMSE),根据国际公认的美国医疗器械促进协会(AAMI)规定的标准进行评价,对比两个模型预测能力。结果 用MIMIC-Ⅲ数据对两个模型进行评价,特征融合模型的MAE、SD符合AAMI标准,RMSE比人工特征参数模型低。用实际收集的重症患者数据对两个模型进行评价,特征融合模型收缩压的SD、舒张压的MAE和SD达到AAMI标准,RMSE也比人工特征参数模型低。结论 特征融合模型的预测能力比人工特征参数模型好。

持续质量改进的临床护理措施对重度子痫前期产妇妊娠结局影响

目的:分析基于持续质量改进的临床护理措施对重度子痫前期(SPE)产妇妊娠结局的影响.方法:采用随机抽样的方式在本院2020年1-2022年12月收治的SPE患者120例作为研究对象,随机数字表法分为对照组和观察组各60例.对照组给予常规护理干预,观察组给予基于持续质量改进的临床护理措施.对比分析两组分娩孕周、分娩方式、血压水平、孕产妇并发症发生率以及新生儿状态.结果:护理干预后两组分娩方式无差异(P>0.05),分娩孕周观察组(37.8±2.8周)高于对照组(36.1±2.9周)(P<0.05);两组血压水平均降低且观察组(126.8±14.0mmHg、88.5±6.8mmHg)均低于对照组(135.5±13.4mmHg、92.5±6.3mmHg).观察组孕产妇并发症发生率(6.7%)低于对照组(20.2%),新生儿Apgar评分(7.8±1.0分)高于对照组(7.1±1.3分),新生儿并发症发生率(11.7%)低于对照组(26.7%)(均P<0.05).结论:基于持续质量改进的临床护理措施可降低SPE患者的血压水平,改善妊娠结局.

持续正压通气对中重睡眠呼吸暂停合并高血压患者血压变异、颈动脉硬化及预后影响

目的:探讨持续气道正压通气(CPAP)对睡眠呼吸暂停低通气综合征(OSAHS)合并高血压患者短期和长期血压变异性(BPV)、颈动脉内膜中层厚度(CIMT)及预后的影响。方法:选取2018年3月—2022年6月郑州市人民医院确诊的142例中重度OSAHS患者作为研究对象。治疗前及治疗3个月、12个月时测定多导睡眠监测、24 h动态血压、CIMT,依据是否接受CPAP治疗措施将患者分为治疗组69例和对照组73例。治疗前、治疗3个月、12个月时比较分析两组BPU及CIMT差异。结果:未调整及校正混杂因素后的模型,呼吸紊乱指数(AHI)分级均为CIMT增厚的危险因素,差异有统计学意义(P<0.05);治疗3个月、12个月时治疗组的标准差值低于对照组,差异有统计学意义(P<0.05)。治疗3个月、12个月时治疗组CIMT低于对照组,差异有统计学意义(P<0.05)。治疗3个月、12个月时,治疗组的卒中发生比例低于对照组,差异有统计学意义(P<0.05)。结论:CPAP应用能够降低中重度OSAHS合并高血压患者BPV并减轻颈动脉粥样硬化程度,改善卒中预后。

氨溴索注射液联合气道压力释放通气治疗急性呼吸窘迫综合征的临床疗效及对患者呼吸力学血气指标的影响

目的探讨氨溴索辅助气道压力释放通气(APRV)治疗急性呼吸窘迫综合征(ARDS)的临床疗效,同时分析该种治疗方案对患者呼吸力学、血气指标的影响。方法本研究为前瞻性研究,选取2020年1月至2022年12月浙江省金华市人民医院接收APRV治疗的128例ARDS患者。在通气过程中,按不同治疗方法分为对照组和研究组,每组均为64例,分别联合0.9%氯化钠注射液和氨溴索注射液辅助治疗。对比2组患者疗效,分析患者呼吸力学、血气指标变化。结果研究组总有效率[90.6%(58/64)与76.6%(49/64)]优于对照组(P<0.05)。治疗3 d后,2组平均气道压(Pmean)、呼吸系统顺应性(Crs)均较治疗前升高,平台压较治疗前降低,且治疗后研究组Pmean、Crs高于对照组,平台压低于对照组(P<0.05)。从趋势图看,2组血气指标均在治疗3 d内出现波动,各指标在时点水平上的差异有统计学意义(P<0.05)。治疗前及治疗后24 h,2组血气指标差异无统计学意义(P>0.05);治疗后48 h、72 h,2组动脉血血氧饱和度(SaO_(2))、动脉血氧分压(PaO_(2))、氧合指数(PaO_(2)/FiO_(2))均较治疗前升高,动脉血二氧化碳分压(PaCO_(2))较治疗前降低,且研究组SaO_(2)、PaO_(2)、PaO_(2)/FiO_(2)高于对照组,PaCO_(2)低于对照组(P<0.05)。结论在ARDS治疗中采取APRV辅助呼吸可以帮助患者改善症状,联合氨溴索治疗可以提高临床总疗效,并进一步改善呼吸力学和血气指标。