俯卧位与仰卧位肺复张对重症肺部感染低氧血症患者疗效的比较研究

Comparative Study on the Effect of Prone and Supine Position Ventilation Combined with Lung Recruitment Maneuver for Patients with Severe Pulmonary Infection Complicated with Hypoxemia

目的对比分析俯卧位与仰卧位联合肺复张对治疗重症肺部感染低氧血症患者的临床效果。方法选取我院2012年7月至2014年11月78例确诊为重症肺部感染低氧血症的患者,随机分成观察组与对照组。观察组40例采取俯卧位肺复张,对照组38例采取仰卧位肺复张。比较两组的基础指标、氧合指数、血流动力学指标的变化以及不良反应情况。结果两组患者治疗后的血氧饱和度、氧合指数相对于治疗前均显著提升,观察组血氧饱和度及氧合指数均显著高于对照组(P<0.05)。肺复张后,两组患者的中心静脉压、心脏指数、全心射血分数、每博指数均显著降低,而全身血管阻力显著增加(P<0.05)。结论两种不同的体位结合肺复张均有效改善患者的血氧参数和呼吸功能,且俯卧位肺复张的治愈效果更优且安全性高。

Objective To compare the clinical effect of prone and supine position ventilation combined with lung recruitment maneuver for patients with severe pulmonary infection complicated with hypoxemia. Methods 78 patients with severe pulmonary infection complicated with hypoxemia admitted to our hospital from July 2012 to November 2014 were selected and randomly divided into two groups. All patients were given lung recruitment maneuver, in which, 40 cases of observation group used prone position, and 38 cases of control group used supine position. The basic indicators, oxygenation indices, hemodynamic parameters and adverse reactions of two groups were compared. Results After therapy, both groups had significantly improved oxygen saturation and oxygenation index, and the observation group was significantly higher than control group in oxygen saturation and oxygenation index （P〈0.05）. After lung recruitment maneuver, both groups had significantly decreased central venous pressure, cardiac index, heart ejection fraction and stroke volume index, and significantly increased systemic vascular resistance （P 〈0.05）. Conclusions For patients with severe pulmonary infection complicated with hypoxemia, both prone position and supine position ventilation combined with lung recruitment maneuver can effectively improve patients＇ blood gas parameters and respiratory function, while the prone position has better cure effect and higher safety.