俯卧位通气在不同疾病人群中的应用  

Application of prone position ventilation in different disease populations

作　　者：方毅敏 陆蓉莉[1] FANG Yi-min;LU Rong-li(Department of Respiratory and Critical Care Medicine,Xiangya Hospital of Central South University,Changsha 410008,China)

机构地区：[1]中南大学湘雅医院呼吸与危重症医学科,湖南长沙410008

出　　处：《中国实用内科杂志》2024年第12期1001-1005,1010,共6页Chinese Journal of Practical Internal Medicine

基　　金：十四五国家重点研发计划项目(2022YFC2504401);湖南省卫生健康委科研计划项目(D202303029041)。

摘　　要：俯卧位通气对呼吸系统的临床意义包括改善氧合、减少呼吸机相关性肺损伤等,但其在不同疾病人群中的应用存在一定争议,且实施细节有所差异。在急性呼吸窘迫综合征(ARDS)患者中,俯卧位通气可改善氧合并降低病死率,其应用时长存在争议,且延长通气时间可能伴随并发症。对胸腹创伤患者实施俯卧位通气虽有效,但难度和风险大,缺乏前瞻性研究。对神经重症患者应用俯卧位通气时,应密切监测颅内压。对肺移植患者应用俯卧位通气可改善供体肺情况,但在术后实施则尚存争议。肥胖患者应用俯卧位通气获益更显著。总之,俯卧位通气策略受多种因素影响,需进一步研究以确定受益人群并制定科学策略。The clinical benefits of prone position ventilation to respirtayory system include improving oxygenation and reducing ventilator-associated lung injury.However,its use in different disease populations remains controversial,with variations in implementation details.In patients with acute respiratory distress syndrome(ARDS),prone position ventilation can improve oxygenation and reduce mortality,though the application duration is debated,as prolonged use may lead to complications.While prone position ventilation is effective in patients with thoracoic and abdominal trauma,it carries significant challenges and risks,and there is a lack of prospective studies.In neurocritical patients,intracranial pressure should be closely monitored during its application.For lung transplant patients,prone position ventilation may improve donor lung function,but its postoperativel use is debated.Obese patients tend to derive more significant benefits from prone position ventilation.In a word,the strategy of prone position ventilation is influenced by various factors,and further research is needed to identify the ideal disease populations and develop evidence-based guidelines.

关 键 词：俯卧位通气 急性呼吸窘迫综合征 胸腹创伤 神经重症 肺移植 肥胖 

分 类 号：R459.9[医药卫生—治疗学]