俯卧位通气联合一氧化氮吸入对急性呼吸窘迫综合征患者氧合的影响

Influence of prone position ventilation in conjunction with inhalation of NO on acute respiratorydistress syndrome in patients

目的评价俯卧位通气（PPV）联合NO吸人对急性呼吸窘迫综合征（ARDS）患者氧合的影响。方法将我院重症医学科2008年9月至2011年1月收治的，应用最佳PEEP后仍需较高的吸入氧体积分数（FIO2≥60％）的21例ARDS患者，随机（随机数字法）分为三组进行对照研究。A组采取单纯NO吸入4h；B组采取俯卧位通气2h，2h后恢复仰卧位通气；C组采取俯卧位通气联合NO吸入2h，2h后恢复仰卧位通气并继续吸人NO。分别测三组患者治疗干预前、2h及4h氧合指数。统计学处理采用SPSS13软件，数据以均数±标准差（x-±s）表示，组间比较用单因素方差分析，组内比较用t检验，P〈0．05为差异有统计学意义。结果与治疗干预前比较，三组患者2h后氧合指数均较前改善，但A组患者差异无统计学意义（P〉0．05），B组和C组患者差异有统计学意义（P〈0．05）；4h后A组和B组氧合指数跟治疗干预前比较无显著差异（P〉0．05），C组氧合指数仍保持改善（P〈0．05）。结论俯卧位通气可以有效地改善严重ARDS患者氧合，俯卧位通气联合NO吸入不但可以改善氧合，而且恢复仰卧位后能有效的维持氧合，因此卧位通气联合NO吸入的方法在改善氧合的同时能减少俯卧位通气时间。

Objective To evaluate the effects of prone position ventilation （PPV） combined with inhalation of NO on oxygenation of acute respiratory distress syndrome （ARDS） patients. Methods A total of 21 patients with ARDS composed of 15 male and 6 female aged ranging from 2 to 74 years with mean age of 39 ± 17.4 years were hospitalized from September 2008 through January 2011. After application of mechanical ventilation with optimal PEEP, patients still needed the high concentration oxygen inhalation （FiO2 ≥ 60% ）. They were randomly （random number） divided into three groups for controlled study. Patients of group A were given NO in addition to oxygen inhalation for 4 hours, patients of group B were put in prone position ventilation with oxygen inhalation for 2 hours, then they were returned to the supine position ventilation, and patients of group C were put into prone position ventilation with inhalation of oxygen plus NO for 2 hours, and then they were returned to the supine position ventilation, but they were continued to inhaled NO. The oxygenation indexes of three groups of patients were measured before the intervention, 2 hours and 4 hours after the procedure of experiment. Results The oxygenation indexes of three groups of patients were improved in terms of comparison between pre-intervention and 2 hours after intervention, but there was no statistically significant difference found in group A （ P 〉 0. 05 ）, the differences in group B and group C were statistically significant （ P 〈 0.05 ）. Compared the oxygen index between pre-intervention and 4 hours after intervention, the differences in group A and group B were not statistically significant （P 〉0.05）, but the difference in group C was statistically significant （P 〈 0. 05 ）. Conclusions PPV could improve oxygenation in acute respiratory distress syndrome （ARDS） patients. PPV with NO inhalation could improve oxygenation in acute respiratory distress syndrome （ARDS） patients as well as effectively maintain the oxygenation after patients were returned to the supine position ventilation. Therefore prone position ventilation combined with inhalation of NO improved oxygenation and at the same time reduced the prone position time.