摘要
目的探讨基于机械能(mechanical power,MP)与跨肺压监测在急性呼吸窘迫综合征(acute respiratory distress syndrome,ARDS)患者肺复张过程中最佳呼气末正压(best positive end-expiratory pressure,Best PEEP)的滴定,分析二者对ARDS患者预后的评估价值。方法选择2021年9月—2023年3月在锦州医科大学附属第一医院重症监护病房治疗的ARDS患者,根据28 d病死率分为存活组和死亡组,在充分镇静后经鼻腔置入食道测压管,采用PEEP递增法实施肺复张(recruitment maneuvers,RM),基于MP和跨肺压滴定Best PEEP,采用Pearson相关分析RM 30 min、2 h MP与跨肺压的相关性;比较不同结局两组RM 30 min及2 h各临床指标的变化趋势;采用受试者工作特征(receiver operating characteristic,ROC)曲线分析2 h MP与跨肺压对ARDS患者28 d病死率预测价值。结果RM 30 min及2 h存活组MP和跨肺压均显著下降,死亡组MP和跨肺压呈现显著上升趋势(均P<0.05);在RM 30 min及2 h Best PEEP、RR比较,存活组均低于死亡组(均P<0.05)。Pearson相关分析结果显示RM 30 min及2 h MP与跨肺压存在显著相关性(r值分别为0.710和0.804,均P<0.05)。MP与跨肺压的ROC曲线下面积分别为0.812和0.795;95%置信区间分别为0.704~0.920和0.687~0.903(均P<0.05);敏感性分别为86.95%和82.50%;特异性分别为76.67%和59.40%;阳性预测值分别为0.851和0.688;阴性预测值分别为0.793和0.759;最佳截断值分别为15.5和17.5。表明RM 2 h MP和跨肺压对ARDS患者28 d病死率具有良好的预测价值。结论在肺复张过程中基于MP与跨肺压监测可有效指导ARDS患者Best PEEP的滴定,并且二者对于ARDS患者预后具有良好的评估价值。
Objective To investigate the titration of best positive end-expiratory pressure(Best PEEP)based on mechanical power(MP)and transpulmonary pressure monitoring during lung reexpansion in patients with acute respiratory distress syndrome(ARDS),and to analyze the value of both in evaluating the prognosis of ARDS patients.Methods ARDS patients treated in the intensive care Unit of the First Affiliated Hospital of Jinzhou Medical University from September 2021 to March 2023 were selected and divided into survival group and death group according to the 28-day mortality rate.After full sedation,esophageal pressure tube was inserted through the nasal passage,and lung recruitment maneuvers(RM)was performed by incremental PEEP method.The Best PEEP method was titrated based on MP and transpulmonary pressure.Pearson correlation analysis was used to analyze the correlation between MP at RM 30 min and 2 h and transpulmonary pressure.The changes of clinical indicators at 30 minutes and 2 hours after RM were compared between the two groups with different outcomes.Receiver operating characteristic(ROC)curve was used to analyze the predictive value of 2 h MP and transpulmonary pressure for 28-day mortality in ARDS patients.Results MP and transpulmonary pressure in the survival group decreased significantly at 30 min and 2 h,while MP and transpulmonary pressure in the death group showed a significant upward trend(P<0.05).The Best PEEP and RR at 30 min and 2 h of the RM in the survival group were lower than those in the death group(P<0.05).Pearson correlation analysis showed that MP at RM 30 min and 2 h was significantly correlated with transpulmonary pressure(r=0.710 and 0.804,P<0.05).The area under the ROC curve of MP and transpulmonary pressure were 0.812 and 0.795,respectively.95%confidencial interval:0.704-0.920 and 0.687-0.903(P<0.05);The sensitivity was 86.95%and 82.50%,respectively.The specificity were 76.67%and 59.40%;The positive predictive values were 0.851 and 0.688;The negative predictive values were 0.793 and 0.759;The
作者
李晓东
李甜
邸兴伟
胡占升
郝春艳
付海燕
姜华茂
LI Xiaodong;LI Tian;DI Xingwei;HU Zhansheng;HAO Chunyan;FU Haiyan;JIANG Huamao(Department of Critical Care Medicine,the First Affiliated Hospital of Jinzhou Medical University,Jinzhou,Liaoning 121000,P.R.China;Department of Respiratory,the Third Affiliated Hospital of Jinzhou Medical University,Jinzhou,Liaoning 121000,P.R.China)
出处
《中国呼吸与危重监护杂志》
CAS
CSCD
北大核心
2023年第10期697-701,共5页
Chinese Journal of Respiratory and Critical Care Medicine
关键词
机械能
跨肺压
ARDS
肺复张
Mechanical power
transpulmonary pressure
acute respiratory distress syndrome
lung recruitment maneuver
