俯卧位通气对急性呼吸窘迫综合征患者血流动力学的影响

Effect of prone position ventilation on hemodynamics in patients with acute respiratory distress syndrome

目的研究俯卧位通气对急性呼吸窘迫综合征(ARDS)患者血流动力学的影响。方法选择2016年9月~2017年9月新疆维吾尔自治区人民医院外科重症监护室收治的ARDS患者64例作为研究对象,先在仰卧位通气状态下测定患者的血气分析指标包括酸碱度(pH)值、动脉血氧分压(PaO_2)、二氧化碳分压(PaCO_2)、脉搏血氧饱和度(SpO_2)、氧合指数(PaO_2/FiO_2)、气道痰液引流量数和血流动力学指标如心率(HR)、平均动脉压(MAP)、中心静脉压(CVP)、心排血量(CO)、心脏指数(CI)、每搏量变异率(SVV)。然后给予患者俯卧位通气,分别在俯卧位通气1、2、3 h和4 h后测定患者上述各指标,比较仰卧位和不同时间点俯卧位的血气分析指标和血流动力学指标。结果俯卧位通气1、2、3 h和4 h PaO_2、PaO_2/FiO_2、SpO_2和气道痰液引流量均高于仰卧位通气,差异均有统计学意义(P<0.05);而pH值、PaCO_2与俯卧位通气比较,差异无统计学意义(P>0.05)。俯卧位通气1、2、3 h和4 h血流动力学指标HR、MAP、CVP、CO、CI、和SVV与仰卧位通气比较,差异均无统计学意义(P>0.05)。俯卧位通气后,15.63%患者出现皮肤黏膜损伤,6.25%血压下降,6.25%呕吐胃内容物,71.88%未观察到不良反应的发生,并且9.38%患者俯卧位通气后无反应。结论 俯卧位通气可明显改善ARDS患者氧合状态,可促进ARDS患者气道痰液引流,对ARDS患者血流动力学无明显影响,纠正了ARDS患者的重力依赖性和不均一性,安全性较好,值得在临床中广泛应用。

Objective To investigate the effect of prone position ventilation on hemodynamics in patients with acute respiratory distress syndrome（ARDS）. Methods From September 2016 to September 2017, 64 cases of ARDS patients admitted to the Intensive Care Unit, Xinjiang Uygur Autonomous Region People′ s Hospital were selected as the research subjects. The blood gas analysis indexes of the patients such as the pH value, arterial oxygen pressure（PaO2）,partial pressure of carbon dioxide（PaCO2）, pulse oxygen saturation（SpO2）, oxygenation index（PaO2/Fi O2）, airway sputum drainage in the airway and the hemodynamic indexes such as heart rate（HR）, mean arterial pressure（MAP）, central venous pressure（CVP）, cardiac output（CO）, cardiac index（CI）, stroke volume variation（SVV） were determined in the supine position ventilation condition. Then the patients were given prone position ventilation, the blood gas analysis indexes and hemodynamic indexes were measured at 1, 2, 3 h and 4 h, respectively. The blood gas analysis indexes and hemodynamic indexes of supine and prone position at different time points were compared. Results PaO2, PaO2/Fi O2, SpO2 and airway sputum drainage at 1, 2, 3 h and 4 h in prone position were all higher than those of supine position, with statistically significant differences（P〈0.05）; but there were no statistically significant differences in pH value and PaCO2 compared with those of supine position（P〉0.05）. There were no statistically significant differences in HR, MAP, CVP, CO, CI and SVV between prone position and supine position（P〉0.05）. After prone position ventilation, 15.63% patients showed skin mucosal injury, 6.25% blood pressure decreased, 6.25% vomited stomach contents, 71.88% had no adverse reactions and 9.38% had no response. Conclusion Prone position ventilation can improve oxygenation in patients with ARDS,promote airway sputum drainage, have no obvious influence on hemodynamics. The gravity dependence and heterogeneity of ARDS patients are corrected. The safety is good. It is worthy of clinical promotion and application.