延长俯卧位通气时间对静脉-静脉体外膜肺氧合支持的急性呼吸窘迫综合征患者的影响  

Effects of extended prone positioning ventilation on ARDS patients with VV-ECMO support

作　　者：童洪杰[1] 张晓玲[1] 赵云鹏 潘飞艳 贾圣伟 王倩倩 Tong Hongjie;Zhang Xiaoling;Zhao Yunpeng;Pan Feiyan;Jia Shengwei;Wang Qianqian(Intensive Care Medicine Department of Jinhua Central Hospital,Jinhua 3210000,China;Intensive Care Medicine Department of the Fourth Affliated Hospital of Zhejiang University School of Medicine,Yiwu 322000,China;Department of Intensive Care Medicine,Jiaxing First Hospital,Jiaxing 314000,China)

机构地区：[1]金华市中心医院重症医学科,金华321000 [2]浙江大学医学院附属第四医院重症医学科,义乌322000 [3]嘉兴市第一医院重症医学科,嘉兴314000

出　　处：《中华急诊医学杂志》2025年第3期389-395,共7页Chinese Journal of Emergency Medicine

基　　金：金华市科技局社发类重点项目(2022-3-103);浙江省中医药科技计划项目(2023ZL188)。

摘　　要：目的 为评估延长单次俯卧位通气时间对静脉-静脉体外膜肺氧合(venous-venous extracorporealmembrane oxygenation,VV-ECMO)支持的急性呼吸窘迫综合征(acute respiratory distress syndrome,ARDS)患者的存活率以及撤机成功率的影响。方法 回顾性纳人2014年9月至2024年5月收住金华市中心医院、浙江大学医学院附属第四医院以及嘉兴市第一医院接受VVECMO支持的ARDS患者的临床资料。收集患者的一般临床资料、ECMO和呼吸机相关的参数以及结局情况。根据单次俯卧位通气时间是否大于24h将患者分为延长俯卧位通气组和俯卧位通气组,比较两组患者临床资料的差异,探讨延长俯卧位通气时间对患者30d存活情况、住院存活情况以及ECMO撤机成功率的影响。通过多因素Logistic回归分析,探索单次俯卧位通气时间与患者ECMO是否撤机成功、30d是否存活和住院是否存活之间的关系。结果 本研究共纳人接受VVECMO支持并实施俯卧位通气的ARDS患者136例,延长俯卧位通气组64例,俯卧位通气组72例,两组患者在30d存活比例(54.7%vs.52.8%)、住院存活比例(51.6%vs.48.6%)、ECMO撤机成功率(57.8%vs.61.1%)、ECMO支持时间[12(10,15)dvs.11(10,13)d]、机械通气时间[16(13,18)dvs.16(12,18)d]、住ICU时间[26(15,32)vs.26(19,29)]以及住院时间[32(15,42)dvs.34(28,35)d]方面差异无统计学意义(P>0.05)。Logistic回归分析提示单次俯卧位通气时间与ECMO撤机是否成功(OR=0.979,95%CI:0.952~1.006)、30d是否存活(OR=1.015,95%CI:0.975~1.056)以及住院是否存活(OR=1.014,95%CI:0.974~1.055)无关联(P>0.05),在校正了病情严重程度、年龄、肺炎种类后仍无关(P>0.05)。结论 对于VV-ECMO支持的ARDS患者,延长单次俯卧位通气时间大于24 h并没有增加患者30d存活率、住院存活率以及ECMO的撤机成功率也没有缩短ECMO的支持时间。Objectives To evaluate the effect of extended single prone positioning ventilation on survival and weaning rate of acute respiratory distress syndrome(ARDS)patients supported by VVECMO.Methods ARDS patients supported by VV-ECMO admitted to Jinhua Central Hospital,the Fourth Affiliated Hospital of Zhejiang University School of Medicine and the First Hospital of Jiaxing from September 2014 to May 2025 were retrospectively enrolled into the study.The clinical data,ECMO and ventilator related parameters and outcomes of the patients were collected.The patients were divided into the extended prone positioning group and prone positioning group according to whether the duration of prone position ventilation was greater than 24 h.The clinical data of the two groups were compared to explore the effects on 30-day survival in-hospital survival and ECMO withdraw rate of these patients.Multivariate logistic regression analysis was used to explore the relationship between the duration of single prone position ventilation and the success of ECMO weaning,30-day survival and hospital survival.Results Total of 163 ARDS patients supported by VV-ECMO receiving prone positioning ventilation were included in study,64 in extended prone positioning group and 72 in prone positioning group.The 30-day survival(54.7%vs.52.8%)in-hospital survival(51.6%vs.48.6%)and ECMO withdraw rate(57.8%vs.61.1%)between the two groups were not statistically different(P>0.05)as well as the duration of ECMO support[12(10,15)d vs.11(10,13)d]the duration of ventilation[16(13,18)d vs.16(12,18)d]the duration of ICU stay[26(15,32)d vs.26(19,29)d]and the duration of hospital stay[32(15,42)d vs.34(28,35)d].Logistic regression analysis revealed that the duration of each prone position ventilation was not associated with successful weaning(OR=0.979,95%CI:0.952-1.006),30-day survival(OR=1.015,95%CI:0.975-1.056)and hospital survival(OR=1.014,95%CI:0.974-1.055)even after adjusting for the severity of illness,age,and type of pneumonia.Conclusions For ARDS patients supporte

关 键 词：仰俯卧位通气 体外膜肺氧合 急性呼吸窘迫综合征 肺膨胀程度 

分 类 号：R47[医药卫生—护理学]