俯卧位通气对高海拔地区肺复张治疗无效急性呼吸窘迫综合征患者氧合的影响  

Effect of prone position on the oxygenation of patients with acute respiratory distress syndrome after failure recruitment maneuvers at high altitudes

作　　者：王文欣[1] 徐波[1] 马胡赛[1] 孟建斌[1] 

机构地区：[1]810000西宁,青海红十字医院ICU

出　　处：《中国危重病急救医学》2012年第10期596-599,共4页Chinese Critical Care Medicine

基　　金：青海省医药卫生科研项目（青卫科新字10-15-206）

摘　　要：目的探讨俯卧位通气对高海拔地区肺复张术（RM）治疗无效急性呼吸窘迫综合征（ARDS）患者的治疗作用。方法从海拔2260m的地区医院筛选RM治疗无效的41例ARDS患者[平均氧合指数（PaOJFiO，）较RM前升高〈20％视为RM无效]，依不同病因分为肺内源性ARDS组（ARDSp组）和肺外源性ARDS组（ARDSexp组），每组再按信封法随机分为俯卧位组和仰卧位组，即ARDSp俯卧位组（11例）、ARDSp仰卧位组（9例）、ARDSexp俯卧位组（10例）、ARDSexp仰卧位组（11例）。在通气前及通气1、2、3、4h监测动脉血氧分脏（PaO2）、PaO2/FiO2、静态顺应性（Cst）、气道阻力（Raw）的变化。结果通气1h时，ARDSexp俯卧位组PaO2/FiO2，（mmHg，1mmHg=0．133kPa）即较通气前显著升高（157．4±40．6比1293±48．7，P〈0．05），并随通气时间延长呈持续增高趋势，4h达峰值（219．1±41．1）；且ARDSexp俯卧位组通气3h内Pa02／FiO：较其他3组显著增高，另3组间则差异无统计学意义。ARDSp俯卧位组、ARDSexp俯卧位组通气4h时PaO2/FiO2均较相应仰卧位组显著增高（208．8±39．7比127．4±47．1，219．1±41．1比124．9±50．8，均P〈0．05）。4组通气前后Cst无显著改变，各组间差异也无统计学意义。ARDSp俯卧位组通气4h时Raw（cmH2O·L-1·S-1）较通气前显著降低（6．8±1．7比10．7±1．8，P〈0．05），且明显低于其他3组；其他3组各时间点Raw组内及组间比较差异均无统计学意义。结论俯卧位通气作为ARDS机械通气重要策略之一，可以改善RM无效高原ARDS患者的氧合，为抢救患者赢得宝贵的时间。Objective To assess the effect of prone position on the oxygenation of patients with acute respiratory distress syndrome （ARDS） after recruitment maneuvers （RM） failure at high altitudes. Methods Forty-one ARDS patients who were invalid for RM therapy at the altitude of 2260 metres area hospital were enrolled [ mean oxygenation index （PaOJFiO2） increased than RM 〈20% considered as RM invalid 1. All were divided into acute respiratory distress syndrome （ARDSp） and extra-acute respiratory distress syndrome （ARDSexp） based on different etiology, and each group was randomly divided into the supine and the prone position group, i.e. that ARDSp prone position group （n = 11 ）, ARDSp supine group （n = 9）, ARDSexp prone position group （n = 10）, and ARDSexp supine group （n ： 11 ）. Before ventilation and 1, 2, 3, 4 hours after ventilation, arterial partial pressure of oxygen （PaO2）, PaO2/FiO2, static lung compliance （Cst）, airway resistance （Raw） were monitored. Results One hour after ventilation in ARDSexp prone position group, PaOJFiO2 （mm Hg, 1 mm Hg-： 0.133 kPa） was significantly higher than before ventilation （157.4 ± 40.6 vs. 129.3 ± 48.7, P〈0.05）, and increased by ventilation time, peaked at 4 hours （219.1 ±41.1 ）. Within 3 hours ventilation in ARDSexp prone position group, PaO2/FiO2 was significantly higher compared with the other three groups, and there were no significant differences among the other three groups. PaOJFiO2 in ARDSp prone position group and ARDSexp prone position group at 4 hours of ventilation were significantly higher compared with the corresponding supine group （208.8 ± 39.7 vs. 127.4 ± 47.1, 219.1 ± 41.1 vs. 124.9 ± 50.8, both P〈 0.05 ）. There was no statistically significant difference in Cst before and after ventilation, and there was no significant changes among the groups. Raw （cm H2O·L-1·s-1） in ARDSp prone position group at 4 hours of ventilation were significantly reduced than before ventilation （6.8

关 键 词：急性呼吸窘迫综合征 俯卧位 机械通气 肺复张术 动脉血气 呼吸力学 

分 类 号：R563.8[医药卫生—呼吸系统]