俯卧位对重度急性呼吸窘迫综合征患者肺血管功能的影响  

Effects of prone position ventilation on pulmonary vascular function in patients with severe acute respiratory distress syndrome

作　　者：提俊响[1] 闫肃[1] 韩冠杰[1] 李家琼[1] 许铁 李茂琴[1] TI Junxiang;YAN Su;HAN Guanjie;LI Jiaqiong;XU Tie;LI Maoqin(Department of Critical Care,Xuzhou Central Hospital,Xuzhou 221009,China)

机构地区：[1]徐州市中心医院重症医学科,江苏徐州221009 [2]徐州医科大学附属医院急救中心,江苏徐州221006

出　　处：《中国急救复苏与灾害医学杂志》2020年第1期68-70,共3页China Journal of Emergency Resuscitation and Disaster Medicine

摘　　要：目的探讨俯卧位通气对重度急性呼吸窘迫综合征(ARDS)患者肺血管功能的影响。方法纳入14例重度急性呼吸窘迫综合征[氧合指数(Pa02/Fi02)<100 mmHg]患者,均使用肺动脉导管监测血流动力学。观察仰卧位和俯卧位通气16 h后氧合指数(PaO2/FiO2)、动脉血二氧化碳分压(PaCO2)、平台压(Pplat)、呼气末正压(PEEP)、驱动压(DP)以及右心房压(PRA)、平均肺动脉压(mPAP)、肺动脉嵌钝压(PAWP)、跨肺梯度(TPG=mPAP-PAWP)、肺血管阻力(PVRi)的变化。结果与仰卧位比较,俯卧位通气16h后PaO2/FiO2,PRA及PAWP明显升高,Pplat、DP、TPG及PVRi明显降低(P<0.05)。结论俯卧位通气可减轻重度ARDS患者肺血管功能障碍。Objective We investigate the effects of prone position ventilation on pulmonary vascular function in patients with severe acute respiratory distress syndrome(ARDS).Methods We recruited 14 patients with severe acute respiratory distress syndrome(PaO2/FiO2<1OOmmHg),hemodynamics were monitored using pulmonary artery catheter.We observed the changes of oxygenation index(PaO2/FiO2),arterial partial pressure of carbon dioxide(PaCO2),plateau pressure(Pplat),positive end-expiratory pressure(PEEP),driving pressure(DP),right citrial pressure(PRA),mean pulrnonaiy artery pressure(mPAP),pulmonary arteiy wedge pressure(PAWP),trans-pulmonaiy gradient(TPG=mPAPPAWP)and pulmonary vascular resistance(PVRi)between the supine and prone position ventilation.Results Compared with the supine position ventilation,we could observe that PaO2/FiO2,PKA and PAWP markedly increased,while Pplat,DP,TPG and PVRi decreased after prone position ventilation for 16 hours(P<0.05).Conclusion Prone position ventilation could decrease pulmonary vascular resistance and attenuate pulmonary vascular dysfunction in patients with severe ARDS.

关 键 词：呼吸窘迫综合征 成人 俯卧位 仰卧位 机械通气 

分 类 号：R459.7[医药卫生—急诊医学]