不同体位患者呼吸机支持对血流动力学的影响

Effects of Ventilation in Different Position on Hemodynamic Indexes in Acute Respiratory Distress Syndrome Patients

目的:观察比较急性呼吸窘迫综合征患者俯卧位与仰卧位姿势使用呼吸机对血流动力学的影响。方法:选取我院呼吸窘迫综合征且符合使用呼吸机指征患者220例,随机分为两组,一组使用俯卧位接受呼吸机支持,另一组仰卧位接受呼吸机支持。比较两组患者血流动力学指标差异。结果:俯卧位通气0.5 h后以及1 h后动脉氧化碳分压和氧合指数优于仰卧位,有统计学显著性;俯卧位通气1 h还可见动脉氧分压水平优于仰卧位组,有统计学显著性。俯卧位通气1 h后心率略高于仰卧位组;俯卧位通气0.5和1 h后平均动脉压略高于仰卧位组。俯卧位通气0.5 h候每搏量和每搏量变异率与仰卧位均存在差异,差异有统计学意义(P<0.05),但1 h后检测数值差异的统计学差异消失。结论:俯卧体位通气可以有效改善ARDS患者的氧合状况,虽然在本研究中未见对血流动力学指标和心排血量指标的明显影响,但不失为一种优于传统体位机械通气的方式,可以尝试在临床中推广使用。

Objective To discuss and compare the effects of prone position and supine position on hemodynamic indexes in ARDS pa-tients using machinenical ventilation. Method 220 cases of ARDS patients were randomly selected and divided into two groups：prone pos-tion group and supine position group. Hemodynamic indexes were compared between the two groups when using machinenical ventila-tion. Results The PaCO2 and PaO2 / FiO2 got better level in prone position group patients after 0. 5 and 1 hour of ventilation than in supine position group and also better level for PaO2 for 1 houre. Slight difference was detected for level of Hr after 1 hour and MAP after both 0. 5 and 1 hour. The level of SV and SVV after 0. 5 hour were better in prone position group but the difference disappeared in 1hour＇s inde-xes. Conclusion Prone position showed better results for oxygenation function in patients of ARDS,slight effect on hemodynamic inde-xes. But it is still a new better choice for the ARDS patients and suggest clinical using.