不同体位保护性通气模式对误吸性急性肺损伤的影响及机制研究  

Effects and mechanism of different postural protective ventilation in patients with aspiration in acute lung injury

作　　者：陈锋[1] 王晨[1] 祝旭清 何宗广[3] 郑静[1] 张茵[1] 

机构地区：[1]台州市立医院呼吸内科,318000 [2]台州市立医院消化内科,318000 [3]台州市立医院ICU,318000

出　　处：《国际呼吸杂志》2013年第12期891-894,共4页International Journal of Respiration

摘　　要：目的研究采用俯卧位和仰卧位保护性通气模式对误吸性急性肺损伤患者的影响，并探讨其机制。方法2009年1月至2012年12月的误吸性急性肺损伤患者60例，随机分为A组和B组，每组30例。两组均采用急诊经纤维支气管镜治疗和保护性通气模式（小潮气量＋呼气末正压通气）辅助通气。A组采取俯卧位，B组仰卧位。检测两组患者治疗前和治疗后24h的呼吸功能、血流动力学指标及血清白介素6（IL-6）、肿瘤坏死因子α（TNF-α）的水平，并随访4周时两组的临床预后。结果A组患者治疗后24h时的动脉血氧分压、氧合指数、脉搏血氧饱和度和心率改善优于B组（P〈O．01），A组患者血清IL-6和TNF-α“的水平显著低于B组（P〈O．01）。治疗后4周A组的病死率（3.33％）低于B组（20.00％）（P〈O．05）。结论俯卧位保护性通气可改善误吸性急性肺损伤患者的临床预后，其机制可能与改善患者呼吸功能和抑制炎症介质有关。Objective To investigate the effect of different position on the clinical prognosis ot acute lung injury of inhalation and to explore the mechanism. Methods 60 patients with acute lung injury of inhalation, which visited our hospital from January 2009 to December 2012, were randomly divided into group A and group B, 30 cases in each group. All cases in both groups received basic treatment of fibro-bronehoscope and low tidal volume ＋ positive end expiratory pressure lung protective ventilation. Cases in group A received ventilation in prone position, and cases in group B received ventilation in supine position. Respiratory function, level of interleukin-6 and tumor necrosis factor-α in both groups were detected before and 24 h after treatment, and clinical prognosis in four weeks after treatment was followed. Results Arterial partial pressure of oxygen, oxygenation index, saturation of pulse oximetry, and heart rate in group A were better than those in group B （ P〈0.01）, and levels of interleukin-6 and tumor necrosis faetor-α in group A were lower than those in group B （ P〈0.01）. The mortality in group A （3.33%） was lower than that in group B （20.00%, P〈0.05）. Conclusions Prone position can improve clinical prognosis of acute lung injury of inhalation, and the mechanism is probably related to improving the respiratory function and inhibiting the inflammatory status.

关 键 词：误吸 急性肺损伤 仰卧位通气 俯卧位通气 

分 类 号：R563.8[医药卫生—呼吸系统]