改良俯卧位机械通气在急性呼吸窘迫综合征患者中的应用

Research of reformative prone position ventilation in patients with acute respiratory distress syndrome

目的 探讨在机械通气的急性呼吸窘迫综合征（ARDS）患者中改良的俯卧位头高脚低倾斜30°机械通气方法,相比常规的俯卧位机械通气的优点.方法 选择行机械通气的ARDS患者44例,按随机数字表法分为俯卧位组和倾斜俯卧位组,每组22例.患者平时持续30°半卧位,每天进行俯卧位机械通气1次,每次4 h.分别记录两组患者在俯卧位机械通气前、中、后血流动力学及呼吸等指标的变化,并作统计学分析.结果 两种俯卧位机械通气后患者的氧合指数均有改善,两组间比较差异无统计学意义（P＞0.05）.与倾斜俯卧位组比较,俯卧位组体位改变后出现肺静态顺应性下降[2h时（25.6±5.8）ml/cm H2O（1 cm H2O=0.098 kPa）比（37.2±20.5）ml/cm H2O],平均气道压上升[2 h时（18.5±3.9）cm H2O比（15.6±5.3）cm H2O],心率增快[2 h时（112.0±16.2）次/min比（102.0±11.3）次/min],平均动脉压下降[2 h时（86.0±6.7）mm Hg（1 mm Hg=0.133 kPa）比（93.5±7.5）mm Hg],中心静脉压上升[2 h时（15.5±3.3）cm H2O比（12.6±4.3）cm H2O];这些改变在俯卧位期间持续存在（P＜0.05）,恢复30°半卧位后1 h消失.结论 改良的俯卧位通气,既有俯卧位改善氧合的作用,又可以避免俯卧位对肺静态顺应性和血流动力学的影响.

Objective To investigate the effect of reformative ventilation method （head-high leg-low 30°-declivate prone position ） in the ventilation of acute respiratory distress syndrome （ ARDS ） patients, and compared with normal prone position ventilation. Methods Forty-four patients of ARDS underwent ventilation were divided into prone position group （22 cases） and reformative prone position group （22cases） by random digits talle. Continuous 30° semireclining position was kept in normal time. The patients of the two groups underwent different prone position ventilation 4 hours every day,and indexes of hemodynamics and respiration before,during and after prone position ventilation were recorded and analyzed. Results After prone position ventilation, oxygenation index of two groups improved similarly （P 〉 0.05 ）. In prone position group, lung compliance decreased [2 h, （ 25.6 ± 5.8 ） ml/cm H2O （ 1 cm H2O = 0.098 kPa） vs. （ 37.2 ± 20.5 ）ml/cm H2O] ,average airway pressure increased [2 h, （ 18.5 ± 3.9） cm H2O vs. （ 15.6 ± 5.3 ）cm H2O] ,heart rate increased [2 h, （ 112.0 ± 16.2 ） beats/min vs. （ 102.0 ± 11.3 ） beats/min], mean arterial blood pressure decreased [2 h, （86.0 ± 6.7） mm Hg （ 1 mm Hg = 0.133 kPa） vs. （93.5 ± 7.5 ） mm Hg] ,central venous pressure increased[2 h, （ 15.5 ± 3.3 ） cm H2O vs. （ 12.6 ± 4.3 ） cm H2O]. These changes persistently existed during prone position ventilation （P 〈 0.05 ）,and they disappeared in 1 hour when recovered to 30 °semireclining position. Conclusion Reformative prone position ventilation not only has same effect on improving oxygenation index, but also obviates adverse effect on lung compliance and hemodynamics.