不同病因急性呼吸窘迫综合征患者侧卧位与俯卧位通气治疗效果分析  

Lateral and Prone Position Ventilation in Patients with Acute Respiratory Distress Syndrome Due to Different Causes:a Comparative Study

作　　者：付祥真 罗霖 刘奎 田洲舟 蒋莉[2] 陈丽[3] FU Xiangzhen;LUO Lin;LIU Kui;TIAN Zhouzhou;JIANG Li;CHEN Li(Department of Cardiology,Affiliated Hospital of North Sichuan Medical College,Nanchong 637000,China;Department of Respiratory and Critical Care Medicine,Affiliated Hospital of North Sichuan Medical College,Nanchong 637000,China;Intensive Care Unit,Affiliated Hospital of North Sichuan Medical College,Nanchong 637000,China)

机构地区：[1]川北医学院附属医院心血管内科,四川省南充市637000 [2]川北医学院附属医院呼吸与危重症医学科,四川省南充市637000 [3]川北医学院附属医院重症医学科,四川省南充市637000

出　　处：《中国全科医学》2021年第23期2919-2926,共8页Chinese General Practice

基　　金：四川省科技计划项目(2018JY0416);四川省南充市市校科技战略合作专项基金(18SXHZ0470)。

摘　　要：背景国内外关于急性呼吸窘迫综合征(ARDS)患者的不同体位机械通气治疗效果有一定的研究,但并未阐明侧卧位通气(LPV)与俯卧位通气(PPV),以及肺内源性ARDS(ARDSp)和肺外源性ARDS(ARDSexp)患者不同体位机械通气的治疗效果差异。目的比较不同病因ARDS患者LPV和PPV治疗效果,探讨其应用策略和价值。方法纳入川北医学院附属医院重症医学科2019年9月—2020年5月收治的85例ARDS患者,本次发病期间尚未进行过体位变化通气治疗。根据病因及通气方法分为ARDSp+LPV组(n=21),ARDSexp+LPV组(n=21),ARDSp+PPV组(n=22),ARDSexp+PPV组(n=21)。监测患者体位变化前和体位变化后0.5 h、1 h、2 h的各项指标变化,包括:(1)基线资料:年龄、性别、体质指数、体温、心率、急性生理与慢性健康评估系统(APACHEⅡ)评分。(2)血气分析监测:动脉血氧分压(PaO_(2))、动脉血二氧化碳分压(PaCO_(2))、动脉血氧饱和度(SaO_(2))和氧合指数(PaO_(2)/FiO_(2))。(3)呼吸力学监测:气道峰压(Ppeak)、呼吸浅快指数(RSBI)、气道平台压(Pplat)和静态肺顺应性(Cst)。(4)重症超声监测左心室射血分数(LVEF)、下腔静脉直径(IVC-D)、左心输出量(CO)、右房室瓣环平面收缩位移(TAPSE)、左房室瓣环平面收缩位移(MAPSE)、左心室舒张早期E峰与左房室侧壁瓣环舒张期e'比值(E/e')和平均动脉压(MAP)。重症肺部超声监测患者肺超声(LUS)评分。(5)心功能指标监测:氨基末端脑钠肽前体(NT-proBNP)。(6)预后情况:患者28 d死亡率和并发症发生率。结果 PaO_(2)/FiO_(2)在时间和方法上存在交互作用(P<0.05),时间在PaO_(2)/FiO_(2)上主效应显著(P<0.05),方法在PaO_(2)/FIO_(2)上主效应显著(P<0.05)。SaO_(2)在时间和方法上存在交互作用(P<0.05),时间在SaO_(2)上主效应显著(P<0.05),方法在SaO_(2)上主效应显著(P<0.05)。PaO_(2)在时间和方法上存在交互作用(P<0.05),时间在PaO_(2)上主效应显著(P<0.05),方法在PaO_(2)�Background The effectiveness of mechanical ventilation by position in patients with acute respiratory distress syndrome(ARDS) has been explored in some studies,but the therapeutic effect differences between lateral position ventilation(LPV) and prone position ventilation(PPV),and between patients with ARDS originating from pulmonary disease(ARDSp) and ARDS originating from extrapulmonary disease(ARDSexp) have not been clarified. Objective To compare the therapeutic effects of LPV and PPV in patients with ARDSp and ARDSexp,and to explore their application strategy and value. Methods 85 patients with ARDS(including ARDSp and ARDSexp patients) who received treatment(without experience of changing ventilation position in this episode prior to this study) in the Intensive Care Unit,Affiliated Hospital of North Sichuan Medical College during September 2019 to May 2020 were enrolled,and divided into four groups for comparing LPV and PPV:ARDSp+ LPV group(n=21),ARDSexp+ LPV group(n=21),ARDSp+ PPV group(n=22) and ARDSexp+ PPV group(n=21).Indices monitored before,and 0.5,1,and 2 hours after changing ventilation position were also collected,including:(1)baseline data such as age,sex,BMI,temperature,heart rate,and APACHE Ⅱ (2) arterial blood gas parameters:partial pressure of oxygen(PaO_(2)),partial pressure of carbon dioxide(PCO_(2)),arterial oxygen saturation(SaO_(2)) and PaO_(2)/FiO_(2) ratio;(3) respiratory mechanical parameters:peak airway pressure(Ppeak),rapid shallow breathing index(RSBI),plateau pressure(Pplat) and static pulmonary compliance(Cst);(4) ICU sonography results:left ventricular ejection fraction(LVEF),inferior vena cava diameter(IVC-D),left ventricular derived cardiac output(CO),tricuspid annular plane systolic excursion(TAPSE),mitral annular plane systolic excursion(MAPSE),ratio of peak E-wave velocity/peak e’ velocity(E/e’),mean arterial pressure(MAP) and lung ultrasound(LUS) score.(5) cardiac biomarker:serum NT-proBNP;(6) prognosis:28-day mortality and incidence of complications. Results PaO_(2)/

关 键 词：呼吸窘迫综合征 成人 肺通气 侧卧位通气 俯卧位通气 超声检查 治疗结果 

分 类 号：R563.8[医药卫生—呼吸系统]