甲型H1N1流行性感冒危重症患者不同体位机械通气效果的临床观察

The influence of different postures on the efficacy of mechanical ventilation in critically ill patients with 2009 H1N1 influenza

对甲型H1N1流行性感冒危重症急性呼吸窘迫综合征的28例患者采取平卧位、侧卧位、半卧位、侧俯卧位和俯卧位各1 h进行机械通气,观察5种不同体位患者心率、呼吸、动脉血氧分压的变化.不同卧位甲型H1N1危重症机械通气对患者呼吸、平均动脉压的影响不大,差异无统计学意义（P＞0.05）;其中侧俯卧位潮气量、平均动脉压、PaO2、静态顺应性、氧化指数的变化差异有统计学意义（P＜0.05）,俯卧位潮气量、平均气道压、PaO2、静态顺应性、氧合指数的变化差异有统计学意义（P＜0.01）.说明俯卧位机械通气能显著改善患者的氧合状态.

28 patients with acute respiratory distress syndrome caused by 2009 H1N1 influenza were mechanically ventilated for 1 hour in the supine, lateral, semi-supine, lateral prone, and prone position respectively. Changes of heart rate, respiratory parameters and arterial partial pressure of oxygen （ PaO2 ）were measured. There were no significant differences （ P 〉 0. 05 ） of heart rate and mean arterial pressure among these postures. Lateral prone （ P 〈 0. 05 ） and prone posture （ P 〈 0. 01 ） , however, can both significantly improve tidal volume, mean airway pressure, PaO2, static lung compliance and oxygenation index. We concluded that mechanical ventilation delivered in the prone position can remarkably improve oxygenation in patients with H1N1 influenza-associated acute lung injury.