俯卧位肺复张对重症肺部感染患者血流动力学的影响  

Effects of recruitment maneuver in prone position on hemodynamics in patients with severe pulmonary infection

作　　者：范远华[1] 刘远飞[1] 朱华勇[1] 张敏[1] 

机构地区：[1]江西省赣州市人民医院ICU,341000

出　　处：《中国危重病急救医学》2012年第2期103-106,共4页Chinese Critical Care Medicine

基　　金：江西省医药卫生科研计划项目（20123203）

摘　　要：目的在肺保护性通气策略的基础上，评价俯卧位条件下肺复张对重症肺部感染患者血流动力学的影响。方法选择江西省赣州市人民医院重症监护病房（ICU）接受机械通气的重症肺部感染患者97例，行定容控制通气，在小潮气量（8ml／kg）＋呼气末正压（PEEP）6cmH2O（1cmH20=0．098kPa）的通气基础上，先后行仰卧位肺复张和俯卧位肺复张（PEEP20cmH2O＋压力控制（PC）20cmH2O]。监测不同体位下肺复张前后心率（HR）、平均动脉压（MAP）、脉搏血氧饱和度（SpO2）、动脉血及混合静脉血的血气分析数据，并经颈内或锁骨下静脉穿刺置人双腔深静脉导管，经股动脉置入脉搏指示连续心排血量（PiCCO）监测导管，持续监测心排血指数（CI）、每搏量指数（SVI）、外周血管阻力指数（SVRI）、胸内血容量指数（ITBVI）、血管外肺水指数（EVLWI）、全心舒张期末容积指数（GEDVI）、全心射血分数（GEF）、每搏量变异（SVV）及中心静脉压（CVP）等参数。结果①与肺复张前比较，仰卧位和俯卧位肺复张后HR、MAP均无显著变化，而SpO2明显升高（仰卧位：0．954±0．032比0．917±0．025，俯卧位：0．982±0．028比0．936±0．039，均P〈0．05）；且俯卧位肺复张后Sp02明显高于仰卧位（P〈0．05）。②与肺复张前比较，仰卧位和俯卧位肺复张即刻CI（L·min^-1·m^-2）、SVI（ml／m2）、GEDVI（ml／m2）、GEF均明显下降（仰卧位：CI3．2±0．4比3．8±0．6，SVI32．4±5．6比38．8±6．5，GEDVI689±44比766±32，GEF0．267±0．039比0．305±0．056；俯卧位：CI3．1±0．5比3．6±0．4，SVI31．2±5．8比37．3±5．0，GEDVI678±41比758±36，GEF0．268±0．040比0．288±0．053，均P〈0．05），CVP（cmH2O）、SVV明显升高[仰卧位：CVP10．7±1．5比8．2±2．5，SVV（11．2±3．3）％比（8．3±4．7）％；俯臣h位：CVP10．3±1．8比8．1±2．5，SVV（12�Objective To evaluate effects of recruitment maneuver in prone position on hemodynamics in patients with severe pulmonary infection, based on the protective pulmonary ventilation strategy. Methods Ninety-seven cases with severe pulmonary infection admitted to intensive care unit （ICU） of Ganzhou City People＇s Hospital undergoing mechanical ventilation were involved. Volume controlled ventilation mode with small tidal volume （8 ml/kg） and positive end-expiratory pressure （PEEP） of 6 cm H20 （ 1 cm H20 = 0.098 kPa） was conducted. Each patient underwent recruitment maneuver in supine position and then in prone position [PEEP 20 cm H2O＋pressure control （PC） 20 cm H2O]. Heart rate （HR）, mean arterial pressure （MAP）, pulse oxygen saturation （SpO2） and blood gas analysis data were recorded before and after recruitment maneuver in either position. A double-lumen venous catheter was inserted into internal jugular vein or subclavian vein, and a pulse index contour cardiac output （PiCCO） catheter was introduced into femoral artery. Cardiac index （CI）, stroke volume index （SVI）, systemic vascular resistance index （SVRI）, intra-thoracic blood volume index （ITBVI）, extra vascular lung water index （EVLWI）, global end-diastolic volume index （GEDVI）, global ejection fraction （GEF）, stroke volume variation （SVV） and central vein pressure （CVP） were monitored. Results ① Compared with data before recruitment maneuver, there were no significant differences in HR and MAP after supine position and prone position recruitment maneuver, but significant differences in SpO2 were found between before and after recruitment maneuver when patients position was changed （supine position： 0.954±0.032 vs. 0.917±0.025, P〈0.05; prone position： 0.982±0.028 vs. 0.936±0.039, P〈0.05）. SpO2 was higher in prone position recruitment maneuver （P〈0.05）. ③Compared with data before recruitment maneuver, CI （L·min^-1·m-2）, SVI （ml/m2）, GEDVI （ml/m2）

关 键 词：肺部感染 俯卧位 肺复张 血流动力学 

分 类 号：R563.1[医药卫生—呼吸系统]