俯卧位通气对急性呼吸窘迫综合征患者腹腔压力影响的研究  

Effect of prone position ventilation on intra - abdominal pressure in patients with acute respiratory distress syndrome

作　　者：蒋文芳[1] 王晓源[1] 侯金珍 罗建宇[1] Jiang Wen-fang;Wang Xiao-yuan;Hou Jin-zhen;Luo Jian-yu(Department of lntensive Care Unit,the People＇s Hospital of Liuzhou,Liuzhou 545006,China)

机构地区：[1]柳州市人民医院重症医学科,广西柳州545006

出　　处：《中国急救医学》2018年第9期799-802,共4页Chinese Journal of Critical Care Medicine

摘　　要：目的 研究俯卧位通气对中重度急性呼吸窘迫综合征（ARDS）患者腹腔压力（IAP）的影响。 方法 采用前瞻性随机对照研究方法，随机选取ICU中60例中重度ARDS患者，其中20例IAP正常的患者为IAP正常组（A组），40例IAP 12～15 mm Hg的患者为IAPⅠ级组（B组）；A组患者均行俯卧位通气，B组患者根据数字随机法分为俯卧位通气组（B1组）及仰卧位通气组（B2组），各20例。记录并比较所有患者通气前及通气后12 h氧合指数（OI）、气道平台压（Pplat）、IAP、腹腔灌注压（APP）、平均动脉压（MAP）、血乳酸（Lac）的变化情况。 结果 在A组中，俯卧位通气后12 h OI较通气前明显升高（P〈0.05），Pplat、Lac较俯卧位通气前下降（P〈0.05），IAP、APP、MAP无统计学意义（P〉0.05）；在B组中，B1组通气后12 h OI较B2组升高（P〈0.05），Pplat、Lac较B2组明显下降（P〈0.05），IAP较俯卧位通气前及B2组有所升高（P〈0.05），但APP、MAP与通气前及B2组比较差异无统计学意义（P〉0.05）；不同IAP下行俯卧位通气治疗12 h后，IAP正常的A组OI、Pplat较B1组改善更明显（P〈0.05）。 结论 腹腔高压（IAH）可影响俯卧位通气效果，但是在中重度ARDS合并轻度IAH患者，俯卧位通气后虽然IAP有轻度增高，但是对APP及血流动力学无明显影响，且可明显提高患者的氧合情况。Objective To investigate the effect of prone position ventilation （PV） on intraabdominal pressure （IAP） in patients with moderate and severe acute respiratory distress syndrome （ARDS）. Methods In this prospective randomized controlled trial, sixty patients with moderate and severe ARDS were selected randomly from the ICU. Twenty patients with normal lAP were normal IAP group （group A）, 40 patients with IAP 12 ~ 15 mm Hg were classified as IAP I group （group B）. All patients in group A received prone ventilation. The patients in group B were divided into prone position ventilation group （ group B1 ） and supine position ventilation group （ group B2） according to the digital randomization method, with 20 cases in each group. Oxygenation index （OI） , airway platform pressure （Pplat）, lAP, abdominal perfusion pressure （APP）, mean arterial pressure （MAP）, and blood lactate （Lac） were measured and compared before and 12 h after ventilation. Results In the normal IAP group, the OI at 12 h after prone position ventilation was significantly higher than that before ventilation （ P 〈 0.05 ） , Pplat and Lac decreased compared with that before prone position ventilation （ P 〈 0.05 ） , and there was no significant difference in IAP, APP and MAP （ P 〉 0.05 ） ; In B group, the OI after 12 - hour ventilation of B1 group was higher than that of B2 group （ P 〈 0.05 ） , Pplat and Lac significantly decreased （ P 〈 0. 05 ）, IAP of B1 group was higher than that before prone position ventilation and B2 group（P 〈0.05） , but there was no significant difference in APP, MAP within each group and between groups before and after ventilation （P 〉 0.05 ）. In patients with different abdominal pressure, OI and Pplat in group A with normal abdominal pressure were improved more obviously than those in group B1 after 12 h of prone position ventilation. Conclusion Intra - abdominal hypertension （IAH） can reduce the effects of prone position ventilation, but i

关 键 词：俯卧位通气 急性呼吸窘迫综合征(ARDS) 腹腔压力(IAP) 腹腔灌注压(APP) 

分 类 号：R563.8[医药卫生—呼吸系统]