基于电阻抗断层成像技术设定呼气末正压对急性呼吸窘迫综合征患者肺功能及肺部并发症的影响

Effect of setting positive end-expiratory pressure based on electrical impedance tomography on pulmonary function and pulmonary complications in patients with acute respiratory distress syndrome

摘要:

目的 探讨在急性呼吸窘迫综合征（ARDS）患者中应用电阻抗断层成像（EIT）技术设定呼气末正压（PEEP）对ARDS患者肺功能及肺部并发症的影响。方法 选取2022年8月—2024年1月青海大学附属医院84例需要行机械通气的ARDS患者为研究对象，按照随机数字表法将患者分为对照组与研究组，每组42例。对照组采用传统的PEEP设定方法，研究组采用基于EIT技术导向PEEP设定方法。比较两组患者PEEP通气后0 h（T₀）、12 h（T₁）、24 h（T₂）、48 h（T₃）的血流动力学指标［平均动脉压（MAP）、心率（HR）］，呼吸力学指标［静态肺顺应性（Cst）、动态肺顺应性（Cdyn）］及血气分析指标［氧合指数（OI）、动脉血pH值］变化情况，比较两组肺部并发症发生率、机械通气时间、重症监护病房住院时间及患者6个月生存率。结果 两组在T₀、T₁、T₂、T₃时的MAP、HR比较，结果 ①不同时间点MAP、HR比较，差异均有统计学意义（P <0.05）；②实验组与对照组MAP、HR比较，差异均无统计学意义（P >0.05）；③两组MAP、HR变化趋势比较，差异均无统计学意义（P >0.05）。两组T₀、T₁、T₂、T₃时Cst、Cdyn水平比较，结果 ①不同时间点Cst、Cdyn水平比较，差异均有统计学意义（P <0.05）；②对照组与研究组Cst、Cdyn水平比较，差异均有统计学意义（P <0.05）；③两组Cst、Cdyn水平变化趋势比较，差异均有统计学意义（P <0.05）。两组T₀、T₁、T₂、T₃时OI水平比较，结果 ①不同时间点OI水平差异有统计学意义（P <0.05）；②对照组与研究组OI水平比较，差异有统计学意义（P <0.05）；③两组OI水平变化趋势比较，差异有统计学意义（P <0.05）。两组T₀、T₁、T₂、T₃时动脉血pH值比较，结果 ①不同时间点动脉血pH值比较，差异无统计学意义（P >0.05）；②对照组与研究组动脉血pH值比较，差异无统计学意义（P >0.05）；③两组动脉血pH值变化趋势比较，差异无统计学意义（P >0.05）。研究组并发症总发生率低于对照组（P <0.05）。研究组机械通气时间短于对照组（P <0.05）。结论 基于EIT技术设定PEEP能够显著改善ARDS患者的肺功能，降低患者治疗过程中肺部并发症的发生率，缩短患者机械通气时间，建议临床推广应用。

Abstract:

Objective To investigate the effects of setting positive end-expiratory pressure (PEEP) based on electrical impedance tomography (EIT) technology on pulmonary function and pulmonary complications in patients with acute respiratory distress syndrome (ARDS).Methods Eighty-four patients with ARDS requiring mechanical ventilation admitted to our hospital from August 2022 to January 2024 were selected as the study subjects and were divided into a study group (42 patients) and a control group (42 patients) using the random number table method. The control group used the traditional PEEP-setting method, and the study group used the EIT technology-based PEEP-setting method. The haemodynamic indexes [mean arterial pressure (MAP), heart rate (HR) ], respiratory mechanics indexes [static lung compliance (Cst), dynamic compliance (Cdyn) ], and blood gas analysis indexes [oxygenation index (OI), arterial blood pH] of the two groups of patients after optimal PEEP ventilation at 0 h (T₀), 12 h (T₁), 24 h (T₂), and 48 h (T₃) were compared. Changes in pulmonary complications, duration of mechanical ventilation, ICU stay, and patients' 6-month survival rate were compared between the two groups.Results Repeated measures analysis of variance showed that there were statistically significant differences in MAP and HR between the two groups at different time points (P < 0.05), but no significant differences were found between the study and control groups (P > 0.05). There were significant differences in Cst and Cdyn levels between and within the two groups at different time points (P < 0.05), and the trends of change were also significantly different (P < 0.05). Significant differences in OI levels were observed between and within the two groups at different time points (P < 0.05), with a significant difference in the trend of change (P < 0.05). No significant differences in arterial blood pH were found between or within the groups at different time points (P > 0.05). The incidence of complications in the study group was lower than that in the control group (P < 0.05). The duration of mechanical ventilation in the study group was shorter than that in the control group (P < 0.05).Conclusion Setting PEEP based on EIT technology can significantly improve the lung function of ARDS patients, reduce the incidence of pulmonary complications, shorten the duration of mechanical ventilation, and is recommended for clinical promotion and application.