胸部電阻抗成像評估呼吸機膨肺與復蘇球囊膨肺肺泡復張效果的差異_Chinese Journal of Respiratory and Critical Care Medicine

Authors：

崔少帥 ¹ , 王靚 ¹ , 陳云霞 ² , 袁聰 ¹ , 忽新剛 ¹ , 李成 ² , 高勝浩 ² , 張文杰 ¹ ,  王海播 ¹

1. ;
2. ;

Corresponding?author：

王海播, Email: haiboqwzx815815@163.com

Keywords：

膨肺; 胸部電阻抗成像; 呼氣末肺阻抗

DOI：

10.7507/1671-6205.201909012

Video：

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目的探討床旁應用胸部電阻抗成像（EIT）實時評估呼吸機膨肺（VHI）和復蘇球囊膨肺（MHI）肺泡復張的效果。方法選取 68 例全麻術后轉入神經重癥加強治療病房的機械通氣患者，隨機分為 MHI 組 34 例和 VHI 組 34 例，入住即刻給予一次膨肺，使用 EIT 技術測量膨肺前（基線）、膨肺時、膨肺后 5、15、30、60 min 的呼氣末肺阻抗（EELI）。結果膨肺時 MHI 組、VHI 組 EELI 分別在基線上增加了 987 AU（95% 可信區間 545～1213）、1187 AU（95% 可信區間 899～1412）。MHI 組在膨肺 5 min 后，EELI 回到基線水平。VHI 組在膨肺 15 min 后，EELI 維持在基線上方 200 AU（95% 可信區間 99～434）；膨肺 30 min 后，VHI 組 EELI 回到基線水平。結論 MHI 和 VHI 均能大幅增加 EELI；相較于 MHI，VHI 可較長時間維持復張肺泡穩定。

Citation： 崔少帥, 王靚, 陳云霞, 袁聰, 忽新剛, 李成, 高勝浩, 張文杰, 王海播. 胸部電阻抗成像評估呼吸機膨肺與復蘇球囊膨肺肺泡復張效果的差異. Chinese Journal of Respiratory and Critical Care Medicine, 2021, 20(2): 132-135. doi: 10.7507/1671-6205.201909012 Copy

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11.	池熠, 何懷武, 袁思依, 等. 電阻抗成像技術監測急性呼吸窘迫綜合征患者呼氣末正壓滴定時局部機械能的臨床應用. 中華重癥醫學電子雜志, 2019, 5(2): 115-119.
12.	徐培峰, 金文揚, 應愛芳, 等. 經氣切口高流量氧療呼氣末正壓效應研究. 中華急診醫學雜志, 2019, 28(12): 1539-1542.
13.	Lachmann B. Open up the lung and keep the lung open. Intensive Care Med, 1992, 18(6): 319-321.
14.	De Monte V, Grasso S, De Marzo C, et al. Effects of reduction of inspired oxygen fraction or application of positive end-expiratory pressure after an alveolar recruitment maneuver on respiratory mechanics, gas exchange, and lung aeration in dogs during anesthesia and neuromuscular blockade. Am J Vet Res, 2013, 74(1): 25-33.
15.	Dennis DM, Duncan CN, Pinder M, et al. Performance of manual hyperinflation: consistency and modification of the technique by intensive care unit nurses during physiotherapy. J Clin Nurs, 2016, 25(15-16): 2295-2304.
16.	Tucci MR, Nakamura MA, Carvalho NC, et al. Manual hyperinflation: is it effective?. Respir Care, 2019, 64(7): 870-873.
17.	Linnane MP, Caruana LR, Tronstad O, et al. A comparison of the effects of manual hyperinflation and ventilator hyperinflation on restoring end-expiratory lung volume after endotracheal suctioning: a pilot physiologic study. J Crit Care, 2019, 49: 77-83.
18.	Savian C, Paratz J, Davies A. Comparison of the effectiveness of manual and ventilator hyperinflation at different levels of positive end-expiratory pressure in artificially ventilated and intubated intensive care patients. Heart Lung, 2006, 35(5): 334-341.

1. Berney S, Denehy L. A comparison of the effects of manual and ventilator hyperinflation on static lung compliance and sputum production in intubated and ventilated intensive care patients. Physiother Res Int, 2002, 7(2): 100-108.
2. Li BG, Martí JD, Comaru T, et al. Short-term appraisal of the effects and safety of manual versus ventilator hyperinflation in an animal model of severe pneumonia. Respir Care, 2019, 64(7): 760-770.
3. Bendixen HH, Hedley-Whyte J, Laver MB. Impaired oxygenation in surgical patients during general anesthesia with controlled ventilation. N Engl J Med, 1963, 269(19): 991-996.
4. Ahmed F, Shafeeq AM, Moiz JA, et al. Comparison of effects of manual versus ventilator hyperinflation on respiratory compliance and arterial blood gases in patients undergoing mitral valve replacement. Heart Lung, 2010, 39(5): 437-443.
5. Diane D, Jacob W, Budgeon C. Ventilator versus manual hyperinflation in clearing sputum in ventilated intensive care unit patients. Anaesth Intensive Care, 2012, 40(1): 142-149.
6. Ukere A, M?rz A, Trepte CJ, et al. Perioperative assessment of regional ventilation during changing body positions and ventilation conditions by electrical impedance tomography. Br J Anaesth, 2016, 117(2): 228-235.
7. Guerin C, Frerichs I. Getting a better picture of the correlation between lung function and structure using electrical impedance tomography. Am J Respir Crit Care Med, 2014, 190(10): 1186-1187.
8. Frerichs I, Hinz J, Herrmann P, et al. Detection of local lung air content by electrical impedance tomography compared with electron beam CT. J Appl Physiol, 2002, 93(2): 660-666.
9. Hinz J, Hahn G, Neumann P, et al. End-expiratory lung impedance change enables bedside monitoring of end-expiratory lung volume change. Intensive Care Med, 2003, 29(1): 37-43.
10. Grant CA, Fraser JF, Dunster KR, et al. The assessment of regional lung mechanics with electrical impedance tomography: a pilot study during recruitment manoeuvres. Intensive Care Med, 2009, 35(1): 166-170.
11. 池熠, 何懷武, 袁思依, 等. 電阻抗成像技術監測急性呼吸窘迫綜合征患者呼氣末正壓滴定時局部機械能的臨床應用. 中華重癥醫學電子雜志, 2019, 5(2): 115-119.
12. 徐培峰, 金文揚, 應愛芳, 等. 經氣切口高流量氧療呼氣末正壓效應研究. 中華急診醫學雜志, 2019, 28(12): 1539-1542.
13. Lachmann B. Open up the lung and keep the lung open. Intensive Care Med, 1992, 18(6): 319-321.
14. De Monte V, Grasso S, De Marzo C, et al. Effects of reduction of inspired oxygen fraction or application of positive end-expiratory pressure after an alveolar recruitment maneuver on respiratory mechanics, gas exchange, and lung aeration in dogs during anesthesia and neuromuscular blockade. Am J Vet Res, 2013, 74(1): 25-33.
15. Dennis DM, Duncan CN, Pinder M, et al. Performance of manual hyperinflation: consistency and modification of the technique by intensive care unit nurses during physiotherapy. J Clin Nurs, 2016, 25(15-16): 2295-2304.
16. Tucci MR, Nakamura MA, Carvalho NC, et al. Manual hyperinflation: is it effective?. Respir Care, 2019, 64(7): 870-873.
17. Linnane MP, Caruana LR, Tronstad O, et al. A comparison of the effects of manual hyperinflation and ventilator hyperinflation on restoring end-expiratory lung volume after endotracheal suctioning: a pilot physiologic study. J Crit Care, 2019, 49: 77-83.
18. Savian C, Paratz J, Davies A. Comparison of the effectiveness of manual and ventilator hyperinflation at different levels of positive end-expiratory pressure in artificially ventilated and intubated intensive care patients. Heart Lung, 2006, 35(5): 334-341.

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胸部電阻抗成像評估呼吸機膨肺與復蘇球囊膨肺肺泡復張效果的差異

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