创伤后急性肺损伤患者行俯卧位通气的研究

To study mechanical ventilation on prone position in patients with ALI induced by trauma

目的 探讨俯卧位通气对ALI/ARDS患者的治疗作用。方法 1998年 7月至 2 0 0 0年 5月收入我院EICU的创伤所致ALI/ARDS患者 2 8例 ,在一定的镇静和肌松下进行俯卧位通气 ,分别监测初始仰位、俯位 1h、俯位 2h、仰位 1h、仰位 2h各时点的血流动力学、呼吸力学及血气分析指标。结果 患者转为俯位后 ,氧合状况显著改善 (PaO2 /FiO2 从 2 0 5 3± 5 7 4升至 2 5 7 0± 2 8 7、 2 73 3± 31 8,P <0 0 5 ) ,且在复转为仰位后 2h持续存在 (PaO2 /FiO2 )为 2 42 1± 6 0 5 ,P <0 0 5 ) ;Bp、HR、Paw、R、C、PaCO2 及血气指标在体位变动前后无明显变化。结论 俯卧位通气能显著改善ALI/ARDS病人的氧合状况 ,对血流动力学、呼吸力学无明显影响 。

Objective To explore the efficacy of mechanical ventilation on prone position in patients with ALI/ARDS.Methods From July 1998 to May 2000,28 cases with ALI/ARDS induced by trauma were admitted to our EICU.Patients were ventilated on prone position under enough sedation and muscle relaxation.In the time of 1h and 2h of supine position(SP)?and prone position(PP),index of haemodymics,respiratory dynamics and arterial blood gas were recorded respectively.Results When patients were turned to prone position,the oxygenation was improved markedly (PaO 2/FiO 2 from 205 3±57 4 to 257 0±28 7?273 3±31 8,P<0 05),and persisted in supine position(PaO 2/FiO 2 242 1±60 5,P<0 05).There were no changes of BP,Hr,P aw ,Raw,Cst,PaCO 2 and so on.Conclusion Oxygenation was to be improved when patients with ARDS were ventilated on prone position,with little influence in haemodymics and respiratory dynemics.Ventilation on prone position can be adopted in patients with ALI/ARDS.