俯卧位通气在重症急性呼吸窘迫综合征临床救治中的价值  

Roles of prone position ventilation in patients with severeacute respiratory distress syndrome

作　　者：唐昊[1] 梁泽平[1] 蒋东坡[1] 杨雪飞[1] 王耀丽[1] 李鹏飞[1] 雷洋[1] 周健[1] 

机构地区：[1]第三军医大学大坪医院重症医学科,重庆400042

出　　处：《中华肺部疾病杂志（电子版）》2016年第4期377-380,共4页Chinese Journal of Lung Diseases(Electronic Edition)

基　　金：国家自然科学基金青年项目(81200057)

摘　　要：目的探讨俯卧位通气对不同程度急性呼吸窘迫综合征(ARDS)患者预后的临床效果。方法回顾性分析2013年1月至2014年1月在第三军医大学大坪医院重症医学科实施俯卧位通气的42例ARDS患者,按照ARDS柏林标准分为轻中度ARDS组20例和重度ARDS组22例。记录人口学资料和临床资料(年龄、性别、APACHEⅡ、SOFA评分、基础疾病数量),及第0、1、3、7天氧合指数情况,预后指标(呼吸机使用时间、带管时间、ICU住院时间、总的住院时间,第28天和90天的病死率)。结果2组患者人口学资料和临床资料,第0、1、3、7天氧合指数之间,呼吸机使用时间、带管时间和总住院时间之间没有统计学差异,重度ARDS组比轻中度ARDS组住院时间更长,P=0.031。轻中度ARDS组28 d和90 d的病死率分别为40%和65%,重度ARDS组28 d和90 d的病死率分别为18.2%和27%,P值分别是0.175和0.006,第90天病死率两组间有统计学差异。结论与轻中度ARDS患者相比,重度ARDS患者住院时间更长,俯卧位通气更能够降低重度ARDS患者的病死率。Objective To evaluate clinical effect of prone position ventilation in patients with different degree of acute respiratory distress syndrome （ARDS）. Methods A retrospective analysis about ARDS patients with prone position ventilation was done from January 2013 to January 2014 in Department of Critical Care Medicine of Daping Hospitalofthe Third Military Medical University, Cases were divided into mild-to- moderate ARDS group and severe ARDS in accordance with the ARDS Berlin standard. It was recorded that demographic data and clinical data （age, gender, number of APACHE ]I , SOFA score, basic diseases）, O, 1, 3, 7 days oxygenation index, prognostic indicators （mechanical ventilation time, intubation time, ICU hospital stay, the total hospital stay, 28 days and 90 days of CFR）. Results There were no statistical difference between two groups patients＇ demographic data and clinical data, 0, 1, 3, 7 days oxygenation index, mechanical ventilation time, intubation time, ICU hospital stay, and the total length of hospital stay. 28 days and 90 days of case fatality rate in mild-to-moderate ARDS group were 40% and 65% respectively, and 28 days and 90 days of case fatality rate in severe ARDS group were 18.2% and 27% respectively, P values were 0.175 and 0. 006, there was statistically significant. Conclusion Compared with patients with mild-to-moderate ARDS, more prone position ventilation can reduce the mortality of patients with severe ARDS.

关 键 词：急性呼吸窘迫综合征 临床特征 俯卧位通气 氧合指数 病死率 

分 类 号：R563.1[医药卫生—呼吸系统]