侧俯卧位通气在急性呼吸窘迫综合征患者中的应用效果分析  

Application effect analysis of lateral prone position ventilation in patients with acute respiratory distress syndrome

作　　者：李琛 张鹏[2] 郑敏 盛冬来 王挺 姜小敢[2] Li Chen;Zhang Peng;Zheng Min;Sheng Donglai;Wang Ting;Jiang Xiaogan(Department of Critical Care Medicine,Jingxian Hospital,Xuancheng 242500,Anhui,China;Department of Critical Care Medicine,Yijishan Hospital,Wannan Medical College,Anhui Clinical Medical Research Center for Critical Respiratory Diseases,Wuhu 241000,Anhui,China)

机构地区：[1]安徽省泾县医院重症医学科,安徽宣城242500 [2]皖南医学院弋矶山医院重症医学科/安徽省危重症呼吸疾病临床医学研究中心,安徽芜湖241000

出　　处：《中华危重病急救医学》2023年第9期939-944,共6页Chinese Critical Care Medicine

基　　金：安徽省医疗卫生重点专科建设项目(2021-273)。

摘　　要：目的探讨侧俯卧位通气在急性呼吸窘迫综合征(ARDS)患者中的应用效果.方法采用前瞻性对照研究方法,选择2020年1月至2022年12月安徽省泾县医院重症医学科收治的75例中重度ARDS患者为研究对象.按照信封法将患者分为侧俯卧位通气组(38例)和传统俯卧位通气(PPV)组(37例),分别采用侧俯卧位通气方式和传统PPV方式.两组患者均按照ARDS救治指南及肺保护性通气需求设置机械通气参数,前3次俯卧位时间每日均不少于16 h.记录患者一般资料,俯卧位前(T0)及俯卧位1 h(T1)、4 h(T2)、8 h(T3)和俯卧位结束前(T4)的心率(HR)、平均动脉压(MAP)、气道阻力、肺静态顺应性(Cst),首次俯卧位前(t0)及入重症监护病房(ICU)12 h(t1)、24 h(t2)、48 h(t3)、72 h(t4)的氧合指数(PaO_(2)/FiO_(2)),以及患者压力性损伤(PI)和呕吐发生率、气管插管时间和机械通气时间.采用重复测量方差分析比较俯卧位前后及不同俯卧位方式对患者的影响.结果两组患者年龄、性别、体质量指数(BMI)、急性生理学与慢性健康状况评分Ⅱ(APACHEⅡ)、基础疾病、HR、MAP、pH值、PaO_(2)/FiO_(2)、血乳酸(Lac)、动脉血二氧化碳分压(PaCO_(2))等一般资料比较差异均无统计学意义.两组T0~T4的HR(组间效应:F=0.845,P=0.361;时间效应:F=1.373,P=0.247;两者交互作用:F=0.245,P=0.894)、MAP(组间效应:F=1.519,P=0.222;时间效应:F=0.169,P=0.954;两者交互作用:F=0.449,P=0.773)和气道阻力(组间效应:F=0.252,P=0.617;时间效应:F=0.578,P=0.679;两者交互作用:F=1.467,P=0.212)比较差异均无统计学意义;两组T0~T4的Cst比较,组间效应(F=0.311,P=0.579)和两者交互作用(F=0.364,P=0.834)差异无统计学意义,而时间效应差异具有统计学意义(F=120.546,P<0.001);两组t0~t4的PaO_(2)/FiO_(2)比较,组间效应(F=0.104,P=0.748)和两者交互作用(F=0.147,P=0.964)差异无统计学意义,而时间效应差异具有统计学意义(F=17.638,P<0.001).对两组的分组因素�Objective To investigate the effect of lateral prone position ventilation in patients with acute respiratory distress syndrome(ARDS).Methods A prospective control study was conducted.A total of 75 patients with moderate to severe ARDS admitted to the department of critical care medicine of Jingxian Hospital in Anhui province from January 2020 to December 2022 were selected as the research objects.According to the envelope method,the patients were divided into the lateral prone position ventilation group(38 cases)and the traditional prone position ventilation(PPV)group(37 cases),using lateral prone position ventilation and traditional PPV,respectively.The mechanical ventilation parameters were set according to the ARDS treatment guidelines and lung protective ventilation requirements in both groups,and the time of prone position for the first 3 times was not less than 16 hours per day.General data of patients were recorded,including heart rate(HR),mean arterial pressure(MAP),airway resistance and lung static compliance(Cst)before prone position(T0),1 hour(T1),4 hours(T2),8 hours(T3),and before the end of prone position(T4),oxygenation index(PaO_(2)/FiO_(2))before the first prone position(t0)and 12 hours(t1),24 hours(t2),48 hours(t3),and 72 hours(t4)after the intensive care unit(ICU)admission,as well as the incidence of pressure injury(PI)and vomiting,tracheal intubation time,and mechanical ventilation time.Repeated measures analysis of variance was used to compare the effects of different prone positions on patients before and after the prone position.Results There were no significant differences in age,gender,body mass index(BMI),acute physiology and chronic health evaluationⅡ(APACHEⅡ),underlying diseases,HR,MAP,pH value,PaO_(2)/FiO_(2),blood lactic acid(Lac),arterial blood pressure of carbon dioxide(PaCO_(2))and other general information between the two groups.The HR(intergroup effect:F=0.845,P=0.361;time effect:F=1.373,P=0.247;interaction:F=0.245,P=0.894),MAP(intergroup effect:F=1.519,P=0.222;time effect:F=

关 键 词：侧俯卧位 俯卧位 急性呼吸窘迫综合征 

分 类 号：R563.8[医药卫生—呼吸系统]