创伤后急性呼吸窘迫综合征俯卧位与侧卧位机械通气效果比较

Treatment of acute respiratory distress syndrome patients with trauma by mechanical ventilation in prone position and lateral recumbent position

目的探讨俯卧位和侧卧位机械通气在多发伤患者急性呼吸窘迫综合征中的应用效果。方法对50例多发伤引起的急性呼吸窘迫综合征患者分别进行俯卧位和侧卧位机械通气，比较两组动脉血气、呼吸循环指标变化。结果两组患者改变体位后动脉血PaCO2无明显变化，PaO2、PaO2／FiO2明显升高（P〈0．01），以PaO2升高大于10mmHg作为有效标准，侧卧位组18例（72％）有效，俯卧位组17例（68％）有效；两组有效率比较差异无统计学意义（P〉0．05）。体位变动对气道峰压、心率和平均动脉压无明显影响。结论俯卧位和侧卧位机械通气均能改善急性呼吸窘迫综合征患者的氧合状况，侧卧位通气更方便实施。

Objective To study the clinical application and treatment of acute respiratory distress syndrome patients with multiple injuries by mechanical ventilation in prone position and lateral recumbent position. Methods Fifty acute respiratory, distress syndrome patients with multiple injuries were allocated to two groups, one group（ n = 25）receiving ventilation in lateral recumbent position, and the other（ n = 25）receiving prone position ventilation. The indices of arterial blood gas;respiration and circulation were compared between the two groups. Results After changed of position, PaCO2 had no significant difference, PaO2, PaO2/FiO2 were significantly increased（P 〈 0.01 ）. If a 10 mmHg increase was regarded as the standard of treatment effectiveness, the effective rates were 72% in the lateral recumbent position group and 68% in the prone position group,without significant difference between the two groups. There were no effects on PIP ,HR and MAP whether the position changed or not. Conclusions Mechanical ventilation in prone position or lateral recumbent position improves oxygenation in patients with acute respiratory distress syndrome, but the lateral position is more convenient in practice.