改良俯卧位通气对急性呼吸窘迫综合征患者呼吸功能及预后的影响  

Effect of Modified Prone Position Ventilation on Respiratory Function and Prognosis in Patients with Acute Respiratory Distress Syndrome

作　　者：白奎[1] 郭凤杰 秦国泉 BAI Kui;GUO Fengjie;QIN Guoquan(ICU,the First Affiliated Hospital Of Henan University,Kaifeng 475000,China)

机构地区：[1]河南大学第一附属医院ICU,河南开封475000

出　　处：《河南医学研究》2024年第3期451-455,共5页Henan Medical Research

基　　金：开封市科技发展计划项目(1803043)。

摘　　要：目的 探究改良俯卧位通气对急性呼吸窘迫综合征(ARDS)患者血流动力学、呼吸动力学及预后的影响。方法 前瞻性选取河南大学第一附属医院2020年3月至2022年6月收治的98例ARDS患者作为研究对象,通过随机数字表法分为A、B组。通过随机及前瞻性平行对照临床研究,评价不同通气方式在ARDS患者中的作用,其中A组52例接受改良式俯卧位通气,B组46例接受传统俯卧位通气。对比两组患者干预前、干预后(俯卧位通气4 h后)血流动力学[心率(HR)、平均动脉压、中心静脉压]、呼吸动力学指标[气道阻力、静态肺顺应性(Cst)]、氧合指数及腹腔压力的变化。比较两组患者不良事件发生情况,对所有患者进行3个月随访,比较两组患者病死率情况。结果 (1)A组机械通气时间低于B组,撤机成功率高于B组(P<0.05);(2)干预后,两组患者HR均较干预前上升,干预前后差值具有统计学意义(P<0.05);(3)干预后,两组Cst水平均较干预前上升且A组高于B组,干预前后差值具有统计学意义(P<0.05);(4)干预后,两组腹腔压力均较治疗前上升且A组低于B组,干预前后差值具有统计学意义(P<0.05);(5)A组不良事件总发生率[7.69%(4/52)]低于B组[23.91%(11/46)](P<0.05);(6)随访3个月结果显示,A组病死率[23.08%(12/52)]低于B组[43.48%(20/46)](P<0.05)。结论 改良俯卧位通气对ARDS血流动力学、呼吸动力学及相关指标均有显著的改善效果,不良事件的发生率较低且预后状况良好,值得临床参考借鉴。Objective To investigate the effect of modified prone position ventilation on hemodynamics,respiratory dynamics and prognosis in patients with acute respiratory distress syndrome(ARDS).Methods Ninety-eight ARDS patients admitted to the First Affiliated Hospital Of Henan University from March 2020 to June 2022 were selected as the study objects and divided into group A and group B by random number table method.A randomized and prospective parallel controlled clinical study was conducted to evaluate the effects of different ventilation methods in ARDS patients.Among them,52 patients in group A received modified prone position ventilation and 46 patients in group B received traditional prone position ventilation.Hemodynamics[heart rate(HR),mean arterial pressure,and central venous pressure],respiratory dynamic indexes[airway resistance,static compliance(Cst)],oxygenation index and abdominal pressure were compared between the two groups before and after intervention.The incidence of adverse events was compared between the two groups.All patients were followed up for 3 months,and the mortality was compared between the two groups.Results(1)The mechanical ventilation time of group A was lower than that of group B,and the success rate of weaning was higher than that of group B(P<0.05).(2)After intervention,HR of patients in both groups increased compared with that before intervention,the difference before and after intervention was statistically significant(P<0.05).(3)After intervention,the level of Cst in the two groups was higher than that before intervention,and the level of Cst in group A was higher than that in group B,the difference before and after intervention was statistically significant(P<0.05).(4)After intervention,abdominal pressure of the two groups were increased compared with those before treatment,and group A was lower than in group B,the difference before and after intervention was statistically significant(P<0.05).(5)The total incidence of adverse events in group A(7.69%,4/52)was lower than that in gro

关 键 词：改良俯卧位通气 急性呼吸窘迫综合征 静态肺顺应性 氧合指数 腹腔压力 预后 

分 类 号：R56[医药卫生—呼吸系统] R45[医药卫生—内科学]