俯卧位肺复张对重症肺部感染低氧血症患者氧合和血流动力学的影响  

Effects of prone position ventilation combined with recruitment maneuver on oxygenation and hemodynamics in patients with severe pulmonary infection

作　　者：范远华[1] 朱华勇[1] 黄振飞[1] 张敏[1] 

机构地区：[1]江西省赣州市人民医院ICU,341000

出　　处：《实用医学杂志》2012年第6期926-929,共4页The Journal of Practical Medicine

摘　　要：目的:评价俯卧位肺复张对改善重症肺部感染低氧血症患者氧合指数、肺内分流的作用及对血流动力学的影响。方法:重症肺部感染患者65例,先后行仰卧位肺复张和俯卧位肺复张。监测肺复张前后血流动力学指标,行血气分析并计算PaO2/FiO2、Qs/QT。结果:(1)两种体位肺复张后SPO2均显著升高(P<0.05),俯卧位肺复张后SPO2较仰卧位肺复张后更高(P<0.05)。(2)仰卧位和俯卧位肺复张后PaO2/FiO2均升高(P<0.05),且俯卧位肺复张前后PaO2/FiO2也均高于仰卧位肺复张前后PaO2/FiO2(P<0.05)。(3)仰卧位和俯卧位肺复张后Qs/QT显著降低(P<0.05),但两种体位间比较无差异。(4)仰卧位和俯卧位肺复张即刻CI、SVI、GEDVI、GEF下降(P<0.05),SVV升高(P<0.05),但复张结束后即恢复至之前水平。两种体位间比较无显著差异。结论:俯卧位通气联合肺复张可以更有效地改善重症肺部感染患者的氧合水平,减少肺内分流,且对血流动力学影响轻微。Objective To evaluate the effects of prone position ventilation combined （PPVC） with recruitment maneuver （RM） on oxygenation, intrapulmonary shunt and hemodynamics in patients with severe pulmonary infection. Methods 65 eases with severe pulmonary infection were involved. Each patient was performed RM in supine position （SP） and prone position （PP） respectively. Hemodynamics index and blood gas data were recorded before and after RM in two positions, PaO2/FiO2 and Qs/QT calculated as well. Results （ 1 ） In both positions, SPO2 was increased after RM （P 〈 0.05）, and PP was increased more evidently than SP （P 〈 0.05）. （2） PaO2/FiO2 was also increased after RM in both positions （P 〈 0.05）, and was increased more evidently in PP. （P 〈 0.05）. （3） Qs/QT was decreased after RM in both positions too （P 〈 0.05）, but there was no significant difference between the two positions. （4） CI, SVI, GEDVI and GEF were decreased significantly during RM （P 〈 0.05）, and SVV increased significantly at the same time （P 〈 0.05）, but they returned to the base level as soon as RM stopped. Conclusions PPVC combined with RM might significantly improve oxygenation and intrapulmonary shunt in severe pulmonary infection patients, but have little influence on hemodynamics.

关 键 词：肺部感染 俯卧位 肺复张 

分 类 号：R563.1[医药卫生—呼吸系统]