振动响应成像：一种评估慢性阻塞性肺疾病急性加重患者无创正压通气初始治疗效果的新型无创工具。

Vibration response imaging: a novel noninvasive tool for evaluating the initial therapeutic effect of noninvasive positive pressure ventilation in patients with acute exacerbation of chronic obstructive pulmonary disease.

机构信息

Department of Respiratory Medicine, the First Affiliated Hospital of China Medical University, Heping district, Shenyang, China.

出版信息

Respir Res. 2012 Aug 2;13(1):65. doi: 10.1186/1465-9921-13-65.

DOI:10.1186/1465-9921-13-65

PMID:22856613

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC3478983/

Abstract

BACKGROUND

The popular methods for evaluating the initial therapeutic effect (ITE) of noninvasive positive pressure ventilation (NPPV) can only roughly reflect the therapeutic outcome of a patient's ventilation because they are subjective, invasive and time-delayed. In contrast, vibration response imaging (VRI) can monitor the function of a patient's ventilation over the NPPV therapy in a non-invasive manner. This study aimed to investigate the value of VRI in evaluating the ITE of NPPV for patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD).

METHODS

Thirty-six AECOPD patients received VRI at three time points: before NPPV treatment (T1), at 15 min of NPPV treatment (T2), and at 15 min after the end of NPPV treatment (T4). Blood gas analysis was also performed at T1 and at 2 hours of NPPV treatment (T3). Thirty-nine healthy volunteers also received VRI at T1 and T2. VRI examination at the time point T2 in either the patients or volunteers did not require any interruption of the on-going NPPV. The clinical indices at each time point were compared between the two groups. Moreover, correlations between the PaCO2 changes (T3 vs T1) and abnormal VRI scores (AVRIS) changes (T2 vs T1) were analyzed.

RESULTS

No significant AVRIS differences were found between T1 and T2 in the healthy controls (8.51 ± 3.36 vs. 8.53 ± 3.57, P > 0.05). The AVRIS, dynamic score, MEF score and EVP score showed a significant decrease in AECOPD patients at T2 compared with T1 (P < 0.05), but a significant increase at T4 compared with T2 (P < 0.05). We also found a positive correlation (R2 = 0.6399) between the PaCO2 changes (T3 vs T1) and AVRIS changes (T2 vs T1).

CONCLUSIONS

VRI is a promising noninvasive tool for evaluating the initial therapeutic effects of NPPV in AECOPD patients and predicting the success of NPPV in the early stage.

摘要

背景

评估无创正压通气（NPPV）初始治疗效果（ITE）的常用方法只能大致反映患者通气治疗的疗效，因为这些方法具有主观性、有创性且存在时间延迟。相比之下，振动反应成像（VRI）可以在无创的情况下监测 NPPV 治疗过程中患者的通气功能。本研究旨在探讨 VRI 在评估慢性阻塞性肺疾病急性加重（AECOPD）患者 NPPV ITE 中的价值。

方法

36 例 AECOPD 患者分别在 3 个时间点（T1、T2 和 T4）接受 VRI 检查：NPPV 治疗前（T1）、NPPV 治疗 15 min 时（T2）和 NPPV 治疗结束后 15 min 时（T4）。T1 和 NPPV 治疗 2 h 时（T3）进行血气分析。39 例健康志愿者也在 T1 和 T2 时接受 VRI 检查。患者或志愿者的 T2 时间点 VRI 检查无需中断正在进行的 NPPV。比较两组各时间点的临床指标。此外，还分析了 PaCO2 变化（T3 与 T1 比较）与异常 VRI 评分（AVRIS）变化（T2 与 T1 比较）之间的相关性。

结果

健康对照组 T1 与 T2 时的 AVRIS 无显著差异（8.51±3.36 与 8.53±3.57，P＞0.05）。AECOPD 患者 T2 时的 AVRIS、动态评分、MEF 评分和 EVP 评分均显著低于 T1 时（P＜0.05），而 T4 时显著高于 T2 时（P＜0.05）。我们还发现 PaCO2 变化（T3 与 T1 比较）与 AVRIS 变化（T2 与 T1 比较）之间存在正相关关系（R2=0.6399）。