俯卧位对机械通气新生儿氧合和肺力学的影响  

Effect of prone positioning on oxygenation and lung mechanics in neonates with mechanical ventilation

作　　者：孙婧婧 黄绮薇 

机构地区：[1]儿童医院新生儿科,上海市200040

出　　处：《中国小儿急救医学》2011年第3期230-232,共3页Chinese Pediatric Emergency Medicine

摘　　要：目的研究俯卧位对机械通气新生儿氧合和肺力学的影响。方法研究对象为2008年5月至2009年2月上海市儿童医院NICU收治的机械通气治疗的新生儿20例，采取交叉设计的方法随机分为仰卧位．俯卧位组和俯卧位一仰卧位组，每组10例。分别采取仰卧位一俯卧位各3h和俯卧位一仰卧位各3h，共6h，记录并分析患儿呼吸机参数、动脉血气和肺力学的改变。结果在呼吸机参数改变无统计学意义的情况下，机械通气新生儿随机选取初始体位，进行自身对照，俯卧位3h的Pa02较仰卧位3h高，差异有统计学意义[（74．50±15．37）mm Hg vs（67．60±13．66）mm Hg（1mm Hg=O．133kPa），P〈0．05]；俯卧位3h的氧合指数较仰卧位高，差异有统计学意义[（201．86±55．96）mm Hg vs（184．38±63．58）mmHg，P〈0．05]；60％（12／20）患儿俯卧位时oI高于仰卧位时，且平均升高17mm Hg。俯卧位3h的分钟通气量、潮气量和肺动态顺应性与仰卧位3h相比有改善，差异有统计学意义（P=0．011，0．020，0．045）；俯卧位时气道阻力下降，但同仰卧位相比差异无统计学意义（P=0．422）。结论机械通气新生儿采取俯卧位时较传统仰卧位相比，可改善氧合、提高PaO2和氧合指数，并可增加分钟通气量和潮气量，改善肺动态顺应性。Objective To investigate the effects of prone positioning on oxygenation and lung mechanics in neonates with mechanical ventilation. Methods Twenty cases of neonates, selected from Shanghai Children＇s Hospital（ from May 2008 to Feb 2009 ）, were randomized to supine-prone position group （ n = 10 ） and prone-supine position group （n = 10 ） using a crossover design. During 6 h, these neonates were placed in the supine position for 3 h then in the prone position for 3 h or in reversed order. The ventilator parameters, re- sults of arterial blood gas and the lung mechanics were recorded. Results Without obvious changes of ventilator parameters,PaO2 improved significantly when the incubated neonates were placed in the prone position for 3 h compared to supine [ （74. 50 ± 15.37） mm Hg vs （67.60 ± 13.66） mm Hg,1 mm Hg =0. 133 kPa, P 〈 0. 05 ）. Similarly, oxygenation index of prone positioning for 3 h was （ 201.86± 55.96 ） mm Hg, which Was higher than that of （ 184. 38 ± 63.58 ） nun Hg, the value of supine positioning for 3 h. There were significant differences （P 〈0. 05）. Our results showed that 60% （12/20） of the neonates responded to prone posi- tioning, with oxysenation index increasing as much as 17 mm Hg on average. Improvement in minute volume, tidal volume and dynamic compliance of the lung were achieved after prone positioning for 3 h （ P = 0. 011, 0. 020,0. 045 ）. The airway resistance did not decrease significantly （ P = 0. 422 ）, but the average decreased in the prone position. Conclusion Oxygenation and the lung mechanics are improved significantly in the nennates with nmne. poitinn eornnnrad with supnine. position.

关 键 词：俯卧位 机械通气 氧合 肺力学 婴儿 新生 

分 类 号：R722.1[医药卫生—儿科]