急性呼吸窘迫综合征患者行侧卧位通气的疗效  

Effect of lateral position ventilation in patients with acute respiratory distress syndrome

作　　者：李全业[1] 张国培[1] 向斌[1] 崔华永[1] 仇正锋[1] 裴金胜[1] 

机构地区：[1]东南大学附属盐城医院重症医学科,江苏盐城224001

出　　处：《临床荟萃》2015年第1期51-53,共3页Clinical Focus

摘　　要：目的探讨侧卧位通气对急性呼吸窘迫综合征(ARDS)患者氧合、血流动力学及痰液引流的影响。方法纳入25例ARDS患者,监测初始仰卧位、侧卧位1小时后、转仰卧位1小时各时间点的平均动脉压(MAP)、心率(HR)、脉搏血氧饱和度(SpO2)、动脉血氧分压(PaO2)、氧合指数(PaO2/FiO2)、痰液引流量等指标。结果与初始仰卧位比较,患者侧卧位1小时PaO2(75±12)mmHg vs(65±11)mmHg,PaO2/FiO2(280±14)mmHg vs(200±20)mmHg明显升高(P<0.05),SpO2(96.5±2.2)vs(88.5±1.2)明显升高(P<0.05),且转仰卧位1小时仍能保持,MAP、HR差异无统计学意义(P>0.05),侧卧位1小时气道痰液引流量较初始仰卧位明显增加(15.2±1.8)ml vs(8.2±2.0)ml(P<0.05)。结论侧卧位通气可改善ARDS患者的氧合,且恢复仰卧位后氧合改善持续存在;可改善气道痰液引流,但对血流动力学、呼吸机力学参数无明显影响。ABSTRACT：Objective To investigate the effects of lateral position ventilation on oxygenation,hemodynamics and airway drainage in patients with acute respiratory distress syndrome（ARDS）.Methods Twenty-five patients with ARDS were recruited in the study.Mean blood pressure（MAP）,heart rate（HR）,pulse oxygen saturation（SpO2 ）, arterial oxygen tension（PaO2 ）,oxygenation index（PaO2/FiO2 ）and sputum drainage were recorded in the time points of initial supine position,lateral position 1 h,and return to supine position 1 h.Results Compared with the time point of initial supine position,PaO2 and PaO2/FiO2 increased significantly after 1 h in prone position,PaO2 ：（75 ± 12） mmHg vs （65 ± 11）mmHg;PaO2/FiO2 ：（280 ± 14）mmHg vs （200 ± 20）mmHg（all P 〈0.05）.The effects of oxygenation improvement were persistent for 1 h after returned to supine position.There was no significant difference in MAP,HR during the study.Airway sputum drainage was significantly increased 1 h after lateral position compared with that initial supine position（15.2±1.8）ml vs （8.2±2.0）ml（P 〈0.05）.Conclusion Lateral position ventilation can improve the oxygenation in patients with ARDS,and the effects of oxygenation improvement can be persistent after returned to supine position.Lateral position ventilation can improve sputum drainage without significant influence on hemodynamics and respiratory mechanics parameters.

关 键 词：呼吸窘迫综合征 成人 通气机 机械 体位 血流动力学 气道引流 

分 类 号：R563[医药卫生—呼吸系统]