床旁肺部超声在重症患者机械通气脱机评估中的应用价值

doi:10.3969/j.issn.1002-1949.2017.11.008

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摘要目的：探讨床旁肺部超声（bedside lung ultrasound, BLU）用于重症患者机械通气（mechanical ventilation, MV）脱机评估的价值，尤其是动态监测MV治疗患者的肺部病变及膈肌功能变化的意义。方法：前瞻性选取2016-03~2016-09入住我院重症医学科（intensive care unit, ICU）符合纳入条件的28例MV患者。进入自主呼吸实验流程15 min后，具有资质的ICU医师使用BLU评估患者肺部及膈肌功能等指标，以帮助指导脱机流程。结果： ①本研究的脱机成功率为89.29%（25/28）。3例患者因呼吸机相关膈肌功能障碍造成脱机困难，其中2例因自动出院而死亡，1例患者经治疗后延时脱机。②膈肌功能（膈肌活动度、膈肌厚度及膈肌增厚率）与浅快呼吸指数、通气时间存在负相关关系（P＜0.05），与APACHEⅡ评分、年龄等因素不存在相关关系（P＞0.05）。结论： MV时间长短与膈肌功能损伤程度密切相关。呼吸机相关膈肌功能障碍的发生可增加MV患者的呼吸机治疗时间和病死率。BLU与浅快呼吸指数等指标联合应用可有效指导重症MV患者脱机评估流程。

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	杨旻
	李惠
	尹路
	张频捷

收稿日期: 2017-04-28

基金资助:2017年国自然青年研究基金（81601661）；安徽省自然科学基金面上项目（1608085MH195）

作者简介: 杨旻（1978-），女，博士，主任医师，硕士生导师，E-mail: 456ym@163.com。

引用本文:

杨旻，李惠，尹路，张频捷. 床旁肺部超声在重症患者机械通气脱机评估中的应用价值[J]. 中国急救医学, 2017, 37(11): 1000-1004.
Yang Min, Li Hui, Yin Lu, Zhang Pin-jie. The value of bedside lung ultrasound evaluation during the weaning from mechanical ventilation in ICU patients. Chinese Journal of Critical Care Medicine, 2017, 37(11): 1000-1004.

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http://www.cnemergency.org.cn/CN/10.3969/j.issn.1002-1949.2017.11.008 或 http://www.cnemergency.org.cn/CN/Y2017/V37/I11/1000

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