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倾斜姿势对心脏的右心室功能的影响:通过食管内心回声评估时,是否可以预测存活率?

Dicle Birtane¹, Zafer Çukurova¹, Sinan Aşar¹

¹University of Health Sciences Türkiye, Bakırköy Dr. Sadi Konuk Training and Research Hospital, Clinic of Anaesthesiology and Reanimation, Intensive Care Unit, İstanbul, Türkiye.

Turkish journal of anaesthesiology and reanimation

|March 21, 2025

概括

倾斜定位 (PP) 改善了右心室 (RV) 功能和氧化在患者的新冠病毒病-2019相关急性呼吸困扰综合征 (C-ARDS). 增加静态合规性 (Cstat) 可能通过保持心肺相互作用而提高生存率,而无需VR功能障碍.

科学领域:

关键护理医学关键护理医学
心脏病学心脏病学
肺部病理学肺部病理学

背景情况:

冠状病毒疾病-2019 (C-ARDS) 可能导致急性呼吸困扰综合征 (ARDS),通常涉及右心室 (RV) 功能障碍.
倾斜定位 (PP) 是已知的ARDS干预措施,但其对VR恢复和C-ARDS整体存活的具体影响需要进一步阐明.

研究的目的:

评估倾斜定位 (PP) 对C-ARDS患者右心室 (RV) 恢复的心肺影响,使用过食管心声学 (TEE).
评估PP对氧化和机械通风参数的影响及其与28天生存时间的关联.

主要方法:

一项前性研究涉及30名中度至重度C-ARDS患者,这些患者接受了侵入性机械通风和PP.
经食道回声心脏图 (TEE) 用于评估RV功能 (RVEDA/LVEDA,TAPSE) 在基线,在PP期间,并在返回仰卧后.
分析了肺部参数 (PaO2 / FiO2,驾驶压力,静态合规性) 和28天生存时间.

主要成果:

倾斜的位置显著改善了RVEDA/LVEDA比率和TAPSE,表明增强了RV恢复.
在氧化 (PaO2 / FiO2),静态合规性 (Cstat) 和驾驶压力 (dP) 降低方面观察到显著改善.
增加的Cstat与28天生存率的改善有关,截止值为37,表明统计学意义.

结论:

倾斜的定位可以改善C-ARDS患者的RV恢复和氧化.
虽然PP改善了关键的生理参数,但它对增加生存率的直接影响需要进一步研究.
在PP期间增加静态合规性可能是通过保持心肺相互作用和预防RV功能障碍来提高生存率的关键.

关键词:

在 ARDS 中,ARDS 是指 ARDS 的类型.肺部符合肺部的要求在俯卧的位置上.呼吸机械学的呼吸机制在右心室内,右心室内.过食管回声心电图 (transesophageal echocardiography) 是一种超食管回声心电图.

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