摘要
目的比较肺电阻抗断层成像(EIT)技术与传统呼气末正压(PEEP)⁃吸入气氧浓度(FiO_(2))表法引导PEEP在创伤性脑损伤(TBI)合并急性呼吸窘迫综合征(ARDS)患者机械通气中的应用效果。方法采用回顾性队列研究分析2020年7月至2022年12月郑州大学附属郑州中心医院收治的80例TBI合并ARDS患者的临床资料,其中男42例,女38例;年龄29~59岁[(42.4±7.8)岁]。格拉斯哥昏迷评分(GCS)3~12分[(7.7±2.2)分]。ARDS分级:轻度33例,中度26例,重度21例。均按肺保护性通气策略行机械通气治疗,42例采用EIT技术引导PEEP(EIT组),38例采用传统PEEP⁃FiO_(2)表法引导PEEP(传统组)。比较两组机械通气治疗后12 h,1、3、5 d的最佳PEEP,以及在各自最佳PEEP下的呼吸力学[驱动压(ΔP)、静态顺应性(C_(St))、机械能(MP)]、肺气体交换[动脉血pH值、动脉二氧化碳分压(PaCO_(2))、氧合指数(P/F)]、气体分布[不均一性指数(GI)、感兴趣区(ROI)1~4]、血流动力学[心率(HR)、中心静脉压(CVP)、平均动脉压(MAP)]、脑灌注情况[颅内压(ICP)、局部脑氧饱和度(rScO_(2))分级];治疗结局(机械通气时间、呼吸机相关性肺损伤(VILI)发生率、ICU住院时间、6个月生存率)。结果患者均获随访6个月。EIT组在机械通气治疗后12 h,1、3、5 d引导的最佳PEEP分别为(7.4±1.0)cm、(8.2±1.2)cm、(9.8±0.8)cm、(8.4±0.7)cm,均高于传统组的(7.0±1.0)cm、(7.6±1.0)cm、(9.0±0.6)cm、(7.2±0.5)cm(P<0.05或0.01)。在各自最佳PEEP下,治疗后12 h,1、3、5 d EIT组ΔP分别为(7.1±1.3)cmH_(2)O、(7.7±1.3)cmH_(2)O、(9.5±1.1)cmH_(2)O、(6.1±1.3)cmH_(2)O,均低于传统组的(8.9±1.3)cmH_(2)O、(10.5±1.3)cmH_(2)O、(11.2±1.2)cmH_(2)O、(8.7±1.2)cmH_(2)O(P<0.05或0.01);EIT组C_(St)分别为(51.5±4.2)ml/cmH_(2)O、(52.9±4.6)ml/cmH_(2)O、(55.1±4.3)ml/cmH_(2)O、(57.5±3.6)ml/cmH_(2)O,均高于传统组的(46.8±3.9)ml/cmH_(2)O、(47.6±4.4)ml/cmH_(2)O、(49.9±4.3)ml/cmH_(2)O、(53.3±3.6)ml/cmH_(2)O(P<0.0
Objective To compare the application effects of electric impedance tomography(EIT)⁃guided positive end⁃expiratory pressure conventional PEEP and PEEP⁃fraction of inspired oxygen(FiO_(2))table⁃guided PEEP in the mechanical ventilation of patients with traumatic brain injury(TBI)complicated with acute respiratory distress syndrome(ARDS).Methods A retrospective cohort study was conducted on the clinical data of 80 TBI patients complicated with ARDS admitted to Zhengzhou Central Hospital Affiliated to Zhengzhou University from July 2020 to December 2022,including 42 males and 38 females,aged 29⁃59 years[(42.4±7.8)years].The Glasgow coma scale(GCS)scores were 3⁃12 points[(7.7±2.2)points].According to ARDS classification,33 were mild,26 moderate and 21 severe.All the patients were treated with mechanical ventilation according to lung protective ventilation strategy,including 42 patients treated with EIT⁃guided PEEP(EIT group)and 38 treated with conventional PEEP⁃FiO_(2) table⁃guided PEEP(conventional group).At 12 hours,1,3 and 5 days after ventilation,the optimal PEEP,respiratory mechanics[driving pressure(ΔP),static compliance(C_(St)),mechanical power(MP)],pulmonary gas exchange[arterial blood pH value,arterial partial pressure of carbon dioxide(PaCO_(2)),oxygenation index(P/F)],ventilation distribution[heterogeneity index(GI),regions of interest(ROI)1⁃4],hemodynamics[heart rate(HR),central venous pressure(CVP),mean arterial pressure(MAP)],cerebral perfusion status[intracranial pressure(ICP),regional cerebral oxygen saturation(rScO_(2))grading],and treatment outcomes(mechanical ventilation duration,incidence of ventilator⁃induced lung injury(VILI),length of ICU stay,6⁃month survival rate)separately at their optimal PEEP were compared between the two groups.Results All the patients were followed up for 6 months.The optimal PEEP of the EIT group was(7.4±1.0)cm,(8.2±1.2)cm,(9.8±0.8)cm and(8.4±0.7)cm respectively at 12 hours,1,3 and 5 days after mechanical ventilation,which were higher than(
作者
徐兰娟
郑惠
刘朋举
刘香漫
刘晓刚
刘静
李丽青
李成建
Xu Lanjuan;Zheng Hui;Liu Pengju;Liu Xiangman;Liu Xiaogang;Liu Jing;Li Liqing;Li Chengjian(Department of Critical Care Medicine,Zhengzhou Central Hospital Affiliated to Zhengzhou University,Zhengzhou 450001,China)
出处
《中华创伤杂志》
CAS
CSCD
北大核心
2024年第5期397-404,共8页
Chinese Journal of Trauma
基金
河南省医学科技攻关计划联合共建项目(LHGJ20230779)。
关键词
脑损伤
呼吸窘迫综合征
电阻抗
Brain injuries
Respiratory distress syndrome
Electric impedance
