俯卧位机械通气对急性肺损伤患者血氧及血流动力学的影响  

Effects of Ventilation in Prone Position on Oxygenation and Hemodynamics in Patients with Acute Lung Injury

作　　者：王云徽[1] 陈朝明[1] 刘荣[1] 钱传云[1] 

机构地区：[1]昆明医学院第一附属医院EICU,云南昆明650032

出　　处：《昆明医学院学报》2010年第10期68-70,74,共4页Journal of Kunming Medical College

基　　金：云南省自然科学基金资助项目(2008ZC120M)

摘　　要：目的探讨俯卧位通气对ALL/ARDS患者血氧情况及血流动力学的影响.方法 2007年7月至2010年6月32例肺内或肺外因素所致ALL/ARD患者在一定镇静和肌松条件下进行俯卧位通气,分别检测俯卧前、俯卧半小时、俯卧1 h、仰卧0.5 h、仰卧1 h各时点的血气分析及HR、MAP、CVP、CO、CI、SV、每搏量变异率(SVV).结果患者转为俯卧位后,氧合状况显著改善(PaO2/FiO2从215.3±58.2升至251.0±25.8和263.3±30.6,P<0.05),且在转为仰卧位1 h后效果依然存在(PaO2/FiO2为214.1±54.5,P<0.05);而MBP、HR、CVP及CO、CI、SV、SVV等指标在体位变动前后没有明显变化.结论俯卧位机械通气可明显改善ALL/ARDS患者氧合情况,且对其血流动力学无明显影响,是较好的治疗措施.Objective To explore the effects of ventilation in prone position on oxygenation and hemodynamics in patients with ALI/ARDS.Methods From July 2007 to June 2010,32 patients with ALI/ ARDS resulting from pulmonary cause（APDSp）and extrapulmonary cause（ARDSexp）were ventilated in prone position under enough sedation and muscle-relaxation.The hemodynamic indexes（HR,MAP,CVP,CO,CI,SV,and SVV）and arterial blood gas of patients were recorded before prone position,0.5 h and 1 h after prone position（PP）and supine position（SP）.Results When patients were turned to prone position,the oxygenation was improved markedly（PaO2/FiO2 from 215.3±58.2 to 251.0±25.8 and 263.3 ±30.6,P〈0.05）,and persisted at 1 h after supine position（PaO2/ FiO2 214.1± 54.5,P〈0.05）.There were no significant changes in HR,MAP,CVP,CO,CI,SV,and SVV before and after position change.Conclusion Ventilation in prone position is a good therapeutic measure for patients with ALL/ARDS,which can improve the oxygenation of patients with little influence on hemodynamics.

关 键 词：急性肺损伤 急性呼吸窘迫综合征 机械通气 俯卧位 

分 类 号：R563.8[医药卫生—呼吸系统]