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中华重症医学电子杂志 ›› 2021, Vol. 07 ›› Issue (04) : 319 -325. doi: 10.3877/cma.j.issn.2096-1537.2021.04.007

临床研究

EIT监测ARDS脱机困难患者早期活动过程中肺部通气变化
周润奭1, 隆云1,(), 李尊柱1, 李奇1, 韩伟2, 袁思依1, 杨玉洁3   
  1. 1. 100730 中国医学科学院 北京协和医学院 北京协和医院重症医学科
    2. 100005 中国医学科学院 基础医学研究所
    3. 100144 中国医学科学院 北京协和医学院护理学院
  • 收稿日期:2021-02-03 出版日期:2021-11-28
  • 通信作者: 隆云
  • 基金资助:
    首都卫生发展科研专项(2020-2-40111)

Study on monitoring lung ventilation during early mobilization in ARDS patients with difficulty of weaning from mechanical ventilation based on electrical impedance tomography technology

Runshi Zhou1, Yun Long1,(), Zunzhu Li1, Qi Li1, Wei Han2, Siyi Yuan1, Yunjie Yang3   

  1. 1. Department of Critical Care Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
    2. Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences, Beijing 100005, China
    3. School of Nursing, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100144, China
  • Received:2021-02-03 Published:2021-11-28
  • Corresponding author: Yun Long
引用本文:

周润奭, 隆云, 李尊柱, 李奇, 韩伟, 袁思依, 杨玉洁. EIT监测ARDS脱机困难患者早期活动过程中肺部通气变化[J/OL]. 中华重症医学电子杂志, 2021, 07(04): 319-325.

Runshi Zhou, Yun Long, Zunzhu Li, Qi Li, Wei Han, Siyi Yuan, Yunjie Yang. Study on monitoring lung ventilation during early mobilization in ARDS patients with difficulty of weaning from mechanical ventilation based on electrical impedance tomography technology[J/OL]. Chinese Journal of Critical Care & Intensive Care Medicine(Electronic Edition), 2021, 07(04): 319-325.

目的

观察电阻抗断层成像术(EIT)监测急性呼吸窘迫综合征(ARDS)脱机困难患者早期活动过程中肺部通气变化。

方法

选取2020年6月至8月入住北京协和医院ICU需进行早期活动的20例ARDS脱机困难患者,根据其早期活动过程中血氧饱和度(SpO2)变化情况,将其分为改善组(SpO2改善,10例)及未改善组(SpO2无变化或下降,10例)。应用EIT监测患者的肺部通气,记录其一般资料及其SpO2,针对其对肺部划分的平行的ROI1~4区(ROI1,ROI2,ROI3,ROI4),记录其早期活动前、早期活动30 min、早期活动60 min、早期活动结束后的区域通气比例。

结果

改善组早期活动30 min[(97.0±1.4)%]及60 min[(97.1±1.5)%]的SpO2明显改善,与早期活动前[(94.1±2.6)%]比较,差异均有统计学意义(t=5.117,P<0.01;t=3.557,P<0.01),同时EIT显示,早期活动30 min[(9.3±6.1)%]及60 min[(10.8±7.2)%]的ROI4区通气状况明显改善,与早期活动前[(4.8±2.7)%]比较,差异有统计学意义(t=2.942,P=0.016;t=2.905,P=0.017)。未改善组早期活动30 min[(97.0±1.7)%]及60 min[(97.1±1.4)%]SpO2下降,与早期活动前[(98.4±1.6)%]比较,差异均有统计学意义(t=8.573,P<0.01;t=4.333,P=0.020),同时EIT显示,仅ROI4区早期活动30 min[(7.6±3.4)%]与早期活动前[(10.3±4.0)%]比较,差异有统计学意义(t=3.199,P=0.011),其他各区早期活动30 min及60 min通气均无明显改善,差异均无统计学意义(P>0.05)。

结论

EIT可以监测和评估重症ARDS脱机困难患者早期活动过程中肺部的通气情况。

Objective

To observe the changes in pulmonary ventilation during early mobilization in ARDS patients with difficulty of weaning from mechanical ventilation under electrical impedance tomography (EIT).

Methods

Twenty ARDS patients with difficulty of weaning from mechanical ventilation admitted to ICU from June to August 2020 who required early mobilization were selected and divided into an improved group (oxygen saturation improved after early mobilization, 10 cases) and a non-improved group (oxygen saturation did not improve after early mobilization, 10 cases) according to their oxygen saturation changes. The EIT was used to monitor the patient's lung ventilation, record the proportion of regional ventilation before, at 30 min, at 60 min, and at the end of early mobilization, for the four parallel ROI zones (ROI1, ROI2, ROI3, and ROI4) which they had divided their lungs.

Results

Oxygen saturation at 30 min [(97.0±1.4)%] and 60 min [(97.1±1.5)%] of early mobilization was significantly improved in the improved group, with statistically significant differences (t=5.117, P<0.01; t=3.557, P<0.01), compared to pre-early mobilization [(94.1±2.6)%]. In addition, EIT monitored a statistically significant improvement in ventilation in ROI 4 zone at 30 min [(9.3±6.1)%] and 60 min [(10.8±7.2)%] of early mobilization, compared with pre-early mobilization [(4.8±2.7)%] (t=2.942, P=0.016; t=2.905, P=0.017). Oxygen saturation decreased in the non-improved group at 30 min [(97.0±1.7)%] and 60 min [(97.1±1.4)%] of early mobilization, compared to [(98.4±1.6)%] pre-early mobilization, with statistically significant differences (t=8.574, P<0.01; t=4.333, P=0.020). The EIT also showed a statistically significant difference (t=3.199, P=0.011) in only ROI4 zone 30 min [(7.6±3.4)%] compared to pre-early mobilization [(10.3±4.0)%], with no significant improvement in 30 min and 60 min ventilation in all other zones (P>0.05).

Conclusion

The EIT can be used in monitoring and assessing of lung ventilation during early mobilization in patients with severe ARDS having difficulty in weaning from mechanical ventilation.

图1 EIT监测患者肺部通气分区示意图注:ROI为兴趣区;EIT为电阻抗断层成像术
表1 2组ARDS患者一般资料比较(
xˉ
±s)
表2 2组ARDS患者活动前中后SpO2结果比较(%,
xˉ
±s)
表3 2组急性呼吸窘迫综合征患者活动前中后ROI1区肺部通气结果比较(%,
xˉ
±s)
表4 2组急性呼吸窘迫综合征患者活动前中后ROI2区肺部通气结果比较(%,
xˉ
±s)
表5 2组急性呼吸窘迫综合征患者早期活动前中后ROI3区肺部通气结果比较(%,
xˉ
±s)
表6 2组急性呼吸窘迫综合征患者活动前中后ROI4区肺部通气结果比较(%,
xˉ
±s)
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