肺部超声引导下胸部物理治疗ARDS的效果研究

目的：探讨肺部超声引导下胸部物理治疗与传统胸部物理治疗对机械通气ARDS肺不张病人的差异性,评估肺部超声在ARDS胸部物理治疗中的价值。方法：入选我院诊断为ARDS的机械通气患者,随机分为对照组(N组)和超声组(L组)进行治疗,每组根据氧合指数分为〈300mmhg,〈200mmhg,〈100mmhg分为3个亚组,N组采用常规机械辅助排痰,L组按超声评分分区排痰,患者入组、治疗24h、48h后分别测定血气分析、肺部超声评分(LUS),观察氧合指数和LUS变化情况并对比分析。结果：共纳入患者104例,48h治疗过程期间排除17例,提前脱机11例,死亡6例,最终纳入87例,N组45例(N1组14例、N2组23例、N3组8例),L组42例(L1组16例、L2组19例、L3组7例)。N1组与L1组24h、48h氧合指数及LUS无明显统计学差异,N2组与L2组24h LUS具有统计学差异(P<0.05),氧合指数无明显统计学差异,48h氧合指数及LUS改善具有明显统计学差异(P<0.05),N3组与L3组24h、48h氧合指数及LUS均无明显统计学差异。结论：与常规方法相比,超声引导在轻度、重度ARDS中改善程度无明显差异,可能与肺损伤及疾病严重程度干扰相关,而在中度ARDS中改善明显提升,提示超声引导下的ARDS胸部物理治疗可能具有更好的治疗效果。

Effect of lung ultrasound-guided chest physical therapy on ARDS

Objective To investigate the differences between lung ultrasound-guided chest physical therapy and traditional chest physiotherapy for ARDS patients with mechanically ventilated, and to evaluate the value of lung ultrasound in ARDS chest physical therapy. Methods Patients selected for mechanical ventilation of ARDS were randomly divided into a control group (group N) and an ultrasound group (group L) for treatment. Each group was divided into <300mmhg, <200mmhg, and <100mmhg into 3 subgroups according to the oxygenation index. The group used conventional mechanically assisted sputum expulsion. The L group was sputum-extracted according to the ultrasound score. At the time of enrollment, 24 hours and 48 hours after treatment, blood gas analysis and pulmonary ultrasound score (LUS) were measured. Results 104 patients were included, 17 patients were excluded during the 48-hour treatment process, 11 patients were improved and extubated, 6 patients died, and finally 87 patients were included, 45 patients in group N (14 patients in group N1, 23 patients in group N2, and 8 patients in group N3). There were 42 cases in the group (16 cases in the L1 group, 19 cases in the L2 group, and 7 cases in the L3 group). The 24h and 48h oxygenation index and LUS of the N1 group and the L1 group were not significantly different, and the 24h LUS of the N2 group and the L2 group were statistically different (P <0.05). There was a significant statistical difference in the improvement of LUS (P <0.05). There was no significant difference in the oxygenation index and LUS at 24h and 48h between the N3 group and the L3 group. Conclusions Compared with conventional methods, ultrasound guidance has no significant improvement in mild and severe ARDS, which may be related to the interference of lung injury and disease severity, while the improvement in moderate ARDS is significantly improved, suggesting that ultrasound-guided ARDS chest physics Treatment may have better therapeutic effects.