俯卧位机械通气治疗急性呼吸窘迫综合征的研究

Therapeutic effect of mechanical ventilation with prone positioning on acute respiratory distress syndrome

目的评价俯卧位机械通气对急性呼吸窘迫综合征(ARDS)治疗的有效性。方法纳入42例ARDS患者,早期给予俯卧位机械通气治疗,观察仰卧位、俯卧位1h、2h、3h、4h以及治疗后8h的动脉血气分析、呼吸频率(RR)、吸入氧浓度(FiO2)、氧合指数(PaO2/FiO2)、胸肺顺应性(C)、气道阻力(Raw)的变化。结果俯卧位机械通气可显著改善患者的氧合状况,有效率为66.7%。俯卧位1h后FiO2及PaO2/FiO2增加至峰值,其后略有下降,但直至治疗后8h,患者的FiO2及PaO2/FiO2仍高于治疗前(P<0.05);治疗后3h RR下降,低于治疗前(P<0.05),而后又有所回升;治疗后1h Raw显著升高(P<0.05),而后又有所下降,而PaCO2、pH值、C和HR、MAP、CVP在治疗前和治疗后无明显变化。结论俯卧位机械通气可显著改善ARDS患者的氧合。

Objective To evaluate the therapeutic effect of mechanical ventilation with prone positioning on acute respiratory distress syndrome （ARDS）. Method 42 patients with ARDS was underwent mechanical ventilated on prone position at early stage. The indexes included arterial blood gas, respiratory rate（RR）, FiO2, PaO2/FiO2, chest lung compliance（C）, and airway resistance（Raw） were evaluated before prone position and after 1 h, 2 h, 3 h, 4 h and 8 h, following back to supine. Results Once the patients were turned to prone position mechanical ventilation, the FiO2 and PaO2/FiO2 were improved markedly, the peak values were occurred in 1 h and then decreased, after 8 h, both FiO2 and PaO2/FiO2 were still higher than pre therapy （ P 〈 0.05）. The RR value decreased after 3 h, and lower than pre treatment （ P 〈 0.05）,then increased slightly. The Raw increased significantly after 1h （ P 〈 0.05）,then decreased slowly. Otherwise, other indexes, including pH value, C, HR, MAP and CVP didn＇ t showed obvious change before and after treatment. Conclusion It demonstrated that oxygenation was improved obviously with mechanical ventilation in prone position.