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胸腔梯度不反映 III 类肥胖患者的叠加压力
Stefano Spina1,2, Lea Mantz3,4, Yi Xin5,6
1Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, USA. sspina@mgh.harvard.edu.
在患有III类肥胖症的患者中,叠加的压力不等于胸腔压力梯度,由于胸部脂肪增加而升高. 这一发现对于在肥胖患者中定制机械通风至关重要.
科学领域:
- 关键护理医学 关键护理医学
- 呼吸系统生理学 呼吸系统生理学
- 肥胖医学 肥胖医学
背景情况:
- 叠加的压力被认为是膜压力梯度的主要决定因素.
- 肥胖与呼吸末端食道压力增加有关,无论肺部疾病的严重程度如何.
- 叠加的压力可能不仅仅决定肥胖个体的膜压力梯度.
研究的目的:
- 测量有或没有III类肥胖症 (BMI ≥40 kg/m2) 的ICU患者的分区呼吸机制和叠加压力.
- 用先进的成像技术量化胸部脂肪组织和肌肉质量.
- 为了研究肥胖,胸部脂肪和胸腔压力梯度之间的关系.
主要方法:
- 针对急性呼吸衰竭的ICU患者进行单中心观察性研究.
- 进行了胸部计算机断层扫描 (CT) 和食道测量.
- 自动化的深度学习管道量化了肺膜,脂肪组织和骨肌肉.
主要成果:
- 与BMI<30 kg/m2的患者相比,BMI≥40 kg/m2的患者的食道压力和胸腔压力梯度较高.
- 叠加压力在各组之间没有显著差异.
- 在肥胖患者中,皮下和胸内脂肪组织的增加与食道压力和胸腔压力梯度正相关.
结论:
- 在III类肥胖症中,叠加的压力不接近膜压力梯度,而膜压力梯度则升高.
- 胸部肥胖会导致胸腔压力梯度增加,在BMI≥40kg/m2的个体中,胸腔压力梯度增加.
- 这些发现支持为高BMI患者量身定制机械通风策略.
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