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find Author "胡占升" 3 results
  • 小剂量甲泼尼龙对中重度急性呼吸窘迫综合征患者肺容积及氧合影响的临床分析

    目的探讨小剂量甲泼尼龙对中重度急性呼吸窘迫综合征(ARDS)患者肺容积及氧合的影响。方法收集 2019 年 6 月至 2020 年 6 月锦州医科大学附属第一医院重症医学科收治的 50 例中重度 ARDS 机械通气患者,按照随机数字表法将患者分为甲泼尼龙试验组和常规治疗对照组,观察患者治疗前后的功能残气量(FRC)、氧合指数(PaO2/FiO2)、血清乳酸(cLac)及超敏 C 反应蛋白(hs-CRP)变化及患者预后相关指标;采用 Pearson 法分析 FRC 与 PaO2/FiO2 的相关性。采用受试者工作特征(ROC)曲线评估 FRC 和 PaO2/FiO2 对 ARDS 患者 28 天病死率的预测价值。结果两组患者治疗后第 4、7 天的 FRC、PaO2/FiO2、PaO2、PaCO2、cLac 及 hs-CRP 均较治疗前改善(均 P<0.05),而且试验组在治疗后的第 4、7 天的 FRC、PaO2/FiO2、PaO2 显著高于对照组,cLac、hs-CRP 及 PaCO2 显著低于对照组(均 P<0.05)。试验组呼吸机使用时间、住院时间、28 天病死率等均低于对照组(均 P<0.05)。FRC 与 PaO2/FiO2 存在显著相关性(r=0.731,P<0.05)。ROC 曲线分析显示,FRC 和 PaO2/FiO2 对中重度 ARDS 患者 28 天病死率均有预测价值,其 ROC 曲线下面积分别为 0.841 和 0.802(均 P<0.05)。结论早期应用小剂量甲泼尼龙可以显著改善中重度 ARDS 患者 FRC 和 PaO2/FiO2,降低 28 天病死率,疗效确切、安全性高,并且通过动态监测 FRC 对于中重度 ARDS 患者预后预测具有较好参考价值。

    Release date:2021-06-30 03:41 Export PDF Favorites Scan
  • Prognostic value of mechanical power and transpulmonary pressure guided recruitment maneuver in patients with acute respiratory distress syndrome

    Objective To investigate the titration of best positive end-expiratory pressure (Best PEEP) based on mechanical power (MP) and transpulmonary pressure monitoring during lung reexpansion in patients with acute respiratory distress syndrome (ARDS), and to analyze the value of both in evaluating the prognosis of ARDS patients.Methods ARDS patients treated in the intensive care Unit of the First Affiliated Hospital of Jinzhou Medical University from September 2021 to March 2023 were selected and divided into survival group and death group according to the 28-day mortality rate. After full sedation, esophageal pressure tube was inserted through the nasal passage, and lung recruitment maneuvers (RM) was performed by incremental PEEP method. The Best PEEP method was titrated based on MP and transpulmonary pressure. Pearson correlation analysis was used to analyze the correlation between MP at RM 30 min and 2 h and transpulmonary pressure. The changes of clinical indicators at 30 minutes and 2 hours after RM were compared between the two groups with different outcomes. Receiver operating characteristic (ROC) curve was used to analyze the predictive value of 2 h MP and transpulmonary pressure for 28-day mortality in ARDS patients. Results MP and transpulmonary pressure in the survival group decreased significantly at 30 min and 2 h, while MP and transpulmonary pressure in the death group showed a significant upward trend (P < 0.05). The Best PEEP and RR at 30 min and 2 h of the RM in the survival group were lower than those in the death group (P < 0.05). Pearson correlation analysis showed that MP at RM 30 min and 2 h was significantly correlated with transpulmonary pressure (r = 0.710 and 0.804, P < 0.05). The area under the ROC curve of MP and transpulmonary pressure were 0.812 and 0.795, respectively. 95% confidencial interval: 0.704 - 0.920 and 0.687 - 0.903 (P < 0.05); The sensitivity was 86.95% and 82.50%, respectively. The specificity were 76.67% and 59.40%; The positive predictive values were 0.851 and 0.688; The negative predictive values were 0.793 and 0.759; The optimal cut-off values were 15.5 and 17.5, respectively. RM 2 h MP and transpulmonary pressure have good predictive value for 28-day mortality in ARDS patients. Conclusion Monitoring MP and transpulmonary pressure during lung recruitment maneuver can effectively guide the titration of Best PEEP in ARDS patients, and both have good evaluation value for the prognosis of ARDS patients.

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  • Predictive value analysis of mechanical power in the weaning outcome of ARDS patients with adaptive mechanical ventilation plus intelligent trigger mode

    Objective To investigate the predictive value of mechanical power (MP) in the weaning outcome of adaptive mechanical ventilation plus intelligent trigger (AMV+IntelliCycle, simply called AMV) mode for acute respiratory distress syndrome (ARDS) patients. Methods From November 2019 to March 2021, patients with mild to moderate ARDS who were treated with invasive mechanical ventilation in the intensive care unit of the First Affiliated Hospital of Jinzhou Medical University were divided into successful weaning group and failed weaning group according to the outcome of weaning. All patients were treated with AMV mode during the trial. The MP, oral closure pressure (P0.1), respiratory rate (RR) and tidal volume (VT) of the two groups were compared 30 min and 2 h after spontaneous breathing trial (SBT). The correlation between 30 min and 2 h MP and shallow rapid respiratory index (RSBI) was analyzed by Pearson correlation. Receiver operating characteristic (ROC) curve was used to analyze the predictive value of 30 min MP in ARDS patients with AMV mode weaning failure. Results Sixty-eight patients were included in the study, 49 of them were successfully removed and 19 of them failed. There was no statistical significance in age, gender, body mass index, oxygenation index, acute physiology and chronic health evaluation Ⅱ score, reasons for mechanical ventilation (respiratory failure, sepsis, intracranial lesions, and others) between the two groups (all P>0.05). The MP, P0.1 and RR at SBT 30 min and 2 h of the successful weaning group was lower than those of the failed weaning group (all P<0.05), but the VT of the successful weaning group was higher than the failed weaning group (all P<0.05). There was a significant relation between the MP at SBT 30 min and 2 h and RSBI (r value was 0.640 and 0.702 respectively, both P<0.05). The area under ROC curve of MP was 0.674, 95% confidence interval was 0.531 - 0.817, P value was 0.027, sensitivity was 71.73%, specificity was 91.49%, positive predictive value was 0.789, negative predictive value was 0.878, optimal cutoff value was 16.500. The results showed that 30 min MP had a good predictive value for the failure of weaning in AMV mode in ARDS patients. Conclusion MP can be used as an accurate index to predict the outcome of weaning in ARDS patients with AMV mode.

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