重度急性呼吸窘迫综合征早期联合不同体位和呼气末正压模式对机械通气评价肺可复张性的临床研究  

Clinical study on evaluation of pulmonary recruitment with different body position and positive end-expiratory pressure mode in stage of mechanical ventilation in severe acute respiratory distress syndrome

作　　者：何开源 罗振吉 王朝晖 李东梅 吴丽秀 He Kaiyuan Luo Zhenji Wang Zhaohui Li Dongmei Wu Lixiu(Department of Severe Medical Science, Nanning Hospital of Traditional Chinese Medicine, Nanning 530000, Chin)

机构地区：[1]南宁市中医医院重症医学科,530000 [2]南宁市中医医院呼吸内科,530000

出　　处：《中国医师进修杂志》2017年第6期504-508,共5页Chinese Journal of Postgraduates of Medicine

摘　　要：目的 评估在不同体位下、采用不同呼气末正压（PEEP）对重度急性呼吸窘迫综合征（ARDS）患者肺复张（RM）的影响.方法 收集2013年6月至2016年6月80例重度ARDS住院患者的临床资料,采用俯卧位（俯卧位组,40例）和仰卧位（仰卧位组,40例）两种不同体位,通过监测患者血流动力学指标[包括心率（HR）、中心静脉压（CVP）、外周动脉压]以及呼吸力学指标[包括呼吸频率（RR）、呼吸系统顺应性（Crs）、气道平台压（Pplate）]及血气分析指标的变化情况,评估在不同体位下、采用PEEP递增法以观察对PM的影响.结果 两组治疗后第3、5、7天氧合指数、动脉血氧分压（PaO2）水平均较治疗后第1天改善,且俯卧位组较仰卧位组在治疗后第3、5天改善更为显著,差异均有统计学意义（P〈0.05）.实施RM后15 min、30 min、1 h、6 h、12 h、24 h的RR、Crs、Pplate水平与RM前比较,差异有统计学意义（P〈0.01）.实施RM后15 min、30 min、1 h、6 h、12 h、24 h的HR、CVP、外周动脉压水平与RM前比较,差异无统计学意义（P〉0.05）.结论 对重度ARDS患者早期实施俯卧位通气联合PEEP递增法进行RM的治疗模式安全可靠,可有效提升氧合水平,有助于提高存活率.Objective To evaluate the effects of pulmonary recruitment （RM） in severe acute respiratory distress syndrome （ARDS） with different body position and positive end-expiratory pressure （PEEP） mode in stage of mechanical ventilation. Methods From June 2013 to June 2016, 80 cases of ICU hospitalized patients with clinical data were enrolled, and they lay in the prone or supine position （prone position group and supine position group, each of 40 cases）. The hemodynamic parameters including heart rate （HR）, central venous pressure （CVP） and peripheral arterial pressure, respiratory mechanics index including respiratory rate （RR）, respiratory system compliance （Crs） and platform pressure （Pplate）, and the changes of blood gas analysis index were monitored to observe the effects of RM in different positions with positive end expiratory pressure increasing method. Results The levels of oxygenation index and arterial partial pressure of oxygen （PaO2） were improved 3, 5 and 7 d after treatment compared with those 1 d after treatment （P〈0.05）, and they were improved significantly in prone position group than those in supine position group 3 and 5 d after treatment （P〈0.05）. The levels of RR, Crs and Pplate 15 min, 30 min, 1 h, 6 h, 12 h and 24 h after RM had significant differences compared with those before RM （P〈0.01）. The levels of HR, CVP, peripheral arterial pressure 15 min, 30 min, 1 h, 6 h, 12 h and 24 h after RM had no significant differences compared with those before RM （P〉0.05）. Conclusions For patients with severe ARDS, early implementation of prone position ventilation combined with PEEP increasing method re-expansion treatment is safe and reliable. It can effectively improve oxygenation level and help to improve the survival rate.

关 键 词：呼吸窘迫综合征 成人 俯卧位 正压呼吸 

分 类 号：R563.8[医药卫生—呼吸系统]