脉搏血氧饱和度／吸入氧浓度的动态监测在重度急性呼吸窘迫综合征患者俯卧位通气中的应用

Application of dynamic monitoring of pulse oxygen saturation/fraction of inhaled oxygen in prone position ventilation in patients with severe acute respiratory distress syndrome

目的探讨脉搏血氧饱和度（SpO2）／吸入氧浓度（FiO2，简称S／F）的动态监测在重度急性呼吸窘迫综合征（ARDS）患者俯卧位通气（PPV）中的应用。方法纳入行PPV治疗的重度ARDS患者49例，根据去甲肾上腺素（NE）的使用剂量将其分为低剂量组（〈0．2μg·kg-1·min-1）23例和高剂量组（≥0．2μg·kg-1·min-1）26例，回顾性分析两组患者俯卧位前、后S／F与动脉血氧分压（PaO2）／FiO2（P／F）的动态变化，并进行相关性分析。结果与俯卧位前比较，所有患者、低剂量组及高剂量组患者的P／F和S／F均升高，差异均有统计学意义（P〈0．01）。所有患者、低剂量组及高级组患者俯卧位前、后及整体的P／F与S／F均呈正相关（r=0．684，0．651，0．671，0．676，0．619，0．65l，0．691，0．653，0．676，P均〈0．01）。所有患者、低剂量组及高剂量组患者PPV治疗过程中P／F和S／F的变化趋势均为先上升后下降。结论重度ARDS患者行PPV治疗时，S／F可以部分替代P／F进行氧合水平的动态监测，NE的使用和PPV治疗均不影响S／F和P／F的相关性。

Objective To explore application of dynamic monitoring of pulse oxygen saturation （ SpO2 ）/fraction of inhaled oxygen （ FiO2, S/F ） in prone position ventilation （ PPV ） in patients with severe acute respiratory distress syndrome（ARDS）. Methods Forty-nine patients with severe ARDS and the application of PPV were divided into low dose group（23 cases, 〈0.2 μg · kg-1 · min-1） and high dose group （26 cases, ≥0. 2 μg · kg - 1· min - 1 ） according to the dose of norepinephrine （NE）. The dynamic changes of S/F and pressure of oxygen（ PaO2 ）/ FiO/（P/F） were analyzed retrospectively, then correlation analysis was performed. Results Compare with before prone position, P/F and S/F in all patients, patients of low dose group and high dose group increased significantly after prone position（P 〈0.01 ）. P/F were all positively correlated with S/F before and after prone position and of overall in all patients, patients of low dose group and high dose group（r =0. 684,0. 651,0. 671,0. 676,0. 619,0. 651,0. 691,0. 653,0. 676,P 〈0.01 ）. In PPV treatment, the change trends of P/F and S/F in all patients, patients of low dose group and high dose group were consistent,which rose at fist and then decreased. Conclusion S/F can partially replace P/F as a dynamic monitoring index of oxygenation level in severe ARDS patients during PPV treatment. Use of NE and PPV treatment have no effect on the correlation of S/F and P/F.