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-  2017 

肺部超声在急性呼吸窘迫综合征患者肺复张治疗中的应用

DOI: doi:10.7507/1671-6205.201704041

Keywords: 肺部超声, 最大氧合法, 急性呼吸窘迫综合征, 肺复张, 超声再气化评分

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Abstract:

目的 评价床旁肺部超声在急性呼吸窘迫综合征(acute respiratory distress syndrome,ARDS)患者肺复张治疗中的应用价值。 方法 选择入住江西省人民医院重症医学科的 60 例 ARDS 患者,随机分为最大氧合法组(n=30)和肺部超声法组(n=30),两组患者均建立人工气道进行机械通气。两组患者进行肺复张过程中分别以最大氧合法和肺部超声法来滴定最佳呼气末正压(positive end-expiratory pressure,PEEP),记录两组患者肺复张前后的动脉血氧分压(arterial partial pressure of oxygen,PaO2)、PEEP 水平、中心静脉压(central venous pressure,CVP)、平均动脉压(mean arterial pressure,MAP)、心排出量(cardiac output,CO)、血管外肺水指数(extravascular lung water index,EVLWI)以及两组不良事件的发生情况。 结果 肺部超声组在肺复张末时 PaO2 高于最大氧合法组(P=0.04),复张末的 PEEP 值也略高,但差异无统计学意义(P=0.910)。两组患者肺复张末的 CVP、MAP、CO、EVLWI 等血流动力学指标比较,差异均无统计学意义(P 均 >0.05)。 结论 床旁肺部超声可以有效地指导 ARDS 患者的肺复张过程,是一种无创、可重复性好、安全经济的方法

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