电阻抗成像技术用于评估两种机械气道廓清技术对气道高分泌的气切患者肺通气和复张效果差异的研究

关键词：肺内振荡及肺复张  高频胸壁震荡  电阻抗成像技术  肺通气  肺复张

Keywords:oscillation and lung expansion  high frequency chest wall  electrical impedance tomography  lung aeration  lung recruitment

摘要：

      摘要 目的：探讨应用电阻抗成像技术（EIT）实时评估气道高分泌的气切患者应用肺内振荡及肺扩张（OLE）和高频胸壁震荡（HFCWO）对肺通气和肺复张效果的差异。 方法：选取60例气道高分泌气管切开患者，采取随机交叉对照设计随机分为先接受HFCWO组（30例）和先接受OLE组（30例）。HFCWO组和OLE组分前后两个阶段相互交叉进行，当首次气道廓清（应用HFCWO或OLE）结束并经过24h洗脱期后，将HFCWO组和OLE组患者对调后进行第二次气道廓清。使用EIT收集两组患者进行气道廓清前基线水平（T0）、廓清后即刻（T1）、30min（T2）、60min（T3）及120min（T4）的通气和复张指标。其中通气指标包括潮气阻抗变化值（TIV）、通气不均一指数（GI），复张指标为呼气末肺内阻抗（EELI）。并记录患者各时间心率、血氧饱和度、血压、呼吸频率变化。 结果：OLE和HFCWO治疗后患者TIV均增加，T4时TIV值分别增加856（95%CI，280—1330）和183（95%CI，﹣200—550），存在组间差异（P＜0.05）。OLE治疗后GI值呈下降趋势（P＜0.05）而HFCWO后各时间GI值与基线对比均未见明显差异。两种治疗后EELI值均增加，而HFCWO组的涨幅从T2开始出现缓平趋势，T4时两组差异最大，OLE后增加563（95%CI，126—953）和HFCWO后增加195（95%CI，27—567）。 结论：相较于HFCWO，OLE可增加气道高分泌的气管切开患者的TIV并降低其GI，能够更好地改善肺通气情况。两种气道廓清技术均可增加EELI，改善肺复张，OLE后EELI增加幅度更大，且效果维持时间更长。

Abstract:

      Abstract Objective： To evaluate the difference in lung aeration and recruitment between oscillation with lung expansion（OLE） and high-frequency chest wall oscillation（HFCWO） in patients with tracheotomy. Method： 60 subjects with tracheotomy were selected from the high dependency unit of respiratory rehabilitation center of Beijing Rehabilitation Hospital， Capital Medical University. The subjects were randomized into the HFCWO first group（30 patients） and the OLE first group（30 patients）. Following a 24-hour washout period after the first treatment, participants crossed over to receive the alternative therapy. The TIV、GI and EELI were collected at baseline levels （T0）， immediately after airway clearance therapy （T1）， after 30 min （T2）， after 60min （T3）， and after 120min （T4） of the therapy. Vital signs,including heart rate， oxygen saturation， blood pressure， and respiratory rate, were also recorded. Result： TIV increased significantly from baseline in both groups after therapy. and reached to 856（95%CI， 280—1330）for OLE and 183 （95%CI， ﹣200—550） for HFCWO at T4 ， with significant difference（P<0.05）. GI showed a significant decreasing trend after OLE therapy (P<0.05 vs. T0), whereas no significant changes in GI were observed after HFCWO. EELI increased significantly after OLE in both groups (P<0.05). However, the increase plateaued after T2 in the HFCWO group. And the difference were statistically significant between all the stages（P<0.05）. EELI at T4 was 563 （95%CI，126—953） in OLE group and 195（95%CI， 27—567） in HFCWO group. Conclusion： Compared to HFCWO, OLE therapy significantly improved lung ventilation. Both these two airway clearance techniques enhanced lung recruitment (increased EELI), but the improvement was significantly greater and sustained longer with OLE therapy.