摘要
目的探讨床旁超声对急性呼吸窘迫综合征(acute respiratory distress syndrome,ARDS)患者肺复张后的最佳呼气末正压(positive end expiratory pressure,PEEP)设置。方法选取2021年7月—2023年7月徐州市第一人民医院收治的50例ARDS患者,随机数字表法分组,对照组与观察组各25例。对照组应用氧合法选择最佳PEEP,观察组应用床旁超声法选择最佳PEEP。比较两组肺复张不同时间点的肺机械力学与血流动力学指标。结果对照组确定的最佳PEEP为(13.60±2.28)cmH_(2)O,观察组确定的最佳PEEP为(15.30±2.84)cmH_(2)O,观察组确定的PEEP高于对照组,差异有统计学意义(P<0.05);两组肺复张前、肺复张后30 min的平均动脉压、心率以及中心静脉压比较,差异无统计学意义(P>0.05);观察组肺复张后30 min的氧合指数与肺动态顺应性水平均高于对照组,差异有统计学意义(P<0.05)。结论在ARDS患者肺复张后确定最佳PEEP时,借助床旁超声进行检查的可行性高,相较于氧合法可使患者的肺氧合指数与肺动态顺应性得到更为有效的改善,此文的研究结果为ARDS患者肺复张后的最佳PEEP设置后期标准制定提供了借鉴内容。
Objective To explore the optimal setting of positive end expiratory pressure(PEEP)for bedside ultrasound in patients with acute respiratory distress syndrome(ARDS)after lung recruitment.Methods A total of 50 patients with ARDS admitted to the First People's Hospital of Xuzhou from July 2021 to July 2023 were selected and divided into five groups by random number table method,with 25 cases in each control group and observation group.The control group used the oxygen balance method to select the optimal PEEP,while the observation group used bedside ultrasound method to select the optimal PEEP.The mechanical and hemodynamic indicators of the lungs at different time points during lung recruitment were compared between the two groups.Results The optimal PEEP determined by the control group was(13.60±2.28)cmH_(2)O,while the optimal PEEP determined by the observation group was(15.30±2.84)cmH_(2)O.The optimal PEEP determined by the observation group was higher than that of the control group,the difference was statistically significant(P<0.05).There was no significant difference in mean arterial pressure,heart rate and central venous pressure before and 30 minutes after lung recruitment between the two groups(P>0.05).The oxygen balance index and dynamic lung compliance levels in the observation group were higher than those in the control group 30 minutes after lung recruitment,with statistically significant differences(P<0.05).Conclusion When determining the optimal PEEP in patients with ARDS after lung recruitment,bedside ultrasound examination is highly feasible.Compared to oxygen therapy,it can effectively improve lung oxygen and index and dynamic lung compliance in patients with ARDS.The research results of this article provide reference content for the later standard setting of optimal PEEP after lung recruitment in ARDS patients.
作者
王旭东
孙延虎
刘雅文
刘妍
史为涛
吴苏明
WANG Xudong;SUN Yanhu;LIU Yawen;LIU Yan;SHI Weitao;WU Suming(Department of Critical Care Medicine,the First People's Hospital of Xuzhou,Xuzhou Jiangsu 221116,China)
出处
《中国卫生标准管理》
2023年第22期108-111,共4页
China Health Standard Management
基金
徐州市卫生健康委科技项目(XWKYHT20220110)。
关键词
急性呼吸窘迫综合征
肺复张
氧合法
床旁超声
呼气终末正压
肺动态顺应性
acute respiratory distress syndrome
pulmonary reexpansion
oxygen sum method
bedside ultrasound
positive end expiratory pressure
dynamic lung compliance
