不同滴定方法对急性呼吸窘迫综合征患者的右心功能和预后的影响
Daoran Dong1, Chengqiao Jing1, Yuan Zong1
1Department of ICU, Shaanxi Provincial People's Hospital, Xi'an, China.
Heart & lung : the journal of critical care
|June 1, 2023
概括
在ARDS患者中,以肺压为导向的PEEP定位可以改善肺功能和氧化,同时减少心脏右侧的压力. 这种方法优于其他PEEP定位策略,用于重症监护患者.
科学领域:
- 临界护理医学 临界护理医学
- 肺部医学 肺部医学
- 心脏病学 心脏病学
背景情况:
- 急性呼吸困扰综合征 (ARDS) 在重症监护室 (ICU) 很普遍.
- 机械通风期间的正端呼吸压力 (PEEP) 可以增加右心脏的后负荷,可能导致右心脏功能障碍和急性肺心脏 (ACP).
- 优化机械通风设置,特别是PEEP,对于管理ARDS患者的右心功能至关重要.
研究的目的:
- 研究三个不同的PEEP定位方法对ARDS患者右心功能的影响.
- 评估这些PEEP定位策略对患者预后的影响.
主要方法:
- 这是一项观察性前性研究,涉及62名ARDS患者.
- 根据PEEP定位策略,患者被分为三组:指导 (G),驱动压力导向 (DPO) 和跨肺压力导向 (TPO).
- 收集的数据包括预后指标,右心静脉和腹静脉功能的心声指数,呼吸参数,血液气体分析和呼吸机制,使用STATA 15进行分析.
主要成果:
- 转肺压力导向 (TPO) 组 (PEEP 12±3 cmH2O) 与驱动压力导向 (DPO) 组 (PEEP 10±2 cmH2O) 和导向 (G) 组 (PEEP 9±2 cmH2O) 相比,显示出明显更高的PEEP值.
- 在TPO和DPO组的72小时后,与G组相比,合规性显著增加.
- 与G组相比,TPO和DPO组的右心功能指数,包括平均气道压力,三环状平面缩外流 (TAPSE) 和右心室面积变化分数 (RVFAC),在TPO和DPO组显著改善. 在TPO组中,E/A指数也更好. 两组之间没有观察到28天死亡率的显著差异. 多变量分析表明,肺部遵守和TPO方法与右心室缩功能障碍有负相关性.
结论:
- 以肺压为导向的PEEP定位有效改善ARDS患者的氧化和肺功能.
- 与机械通风期间的其他PEEP定位策略相比,这种方法导致心脏右侧应力较小.
- 推使用TPO方法来治疗需要机械呼吸的ARDS患者,以优化右心功能.
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