俯卧位通气卷心式操作新方法

A New Method of Ventilation Rolling Heart Operation in Prone Position

自1949年Ecker提出俯卧位手术体位后,学者对俯卧位通气(prone position ventilation,PPV)进行了多方面的研究,1974年Byran首次发现麻醉患者俯卧位可以改善氧合状态,通过PPV能增加功能残气量,改善通气血流比值,减少分流,改变膈肌的运动方式和位置,促进分泌物的排出,增加肺的顺应性.至今为止PPV已被认为是纠正急性呼吸窘迫综合征(acute respiratory distress syndrome,ARDS)和急性肺损伤(acute lung injury,ALI)患者难治性低氧血症的一种有效、经济的治疗措施.近期Claude Guerin等进行的一项前瞻性、多中心、随机对照研究也表明早期长程PPV大约有50%-70%的患者能提高动脉氧分压,降低吸氧浓度,严重ARDS患者28-90d的死亡率明显降低.Fridrich等通过大量的研究也表明上述并发症的发生率很低,只有0.7%.

Since Ecker put forward the position of prone position operation in 1949, scholars have studied prone position ventilation (PPV) in many ways,Byran first discovered in 1974 that prone position can improve oxygenation in anesthetized patients,PPV can increase functional residual gas, improve the ratio of ventilation to blood flow, reduce shunt, change the movement mode and position of the diaphragm, promote the discharge of secretions, and increase lung compliance.So far PPV has been considered as an effective and economical treatment for refractory hypoxemia in patients with acute respiratory distress syndrome (ARDS) and acute lung injury (ALI).A recent prospective, multicenter, randomized controlled study by Claude Guerin et al also showed that about 50% to 70% of patients with early long-term PPV could increase arterial partial pressure of oxygen and reduce oxygen uptake concentration, mortality in patients with severe ARDS was significantly reduced at 28-90 days.Fridrich et al through a large number of studies also showed that the incidence of these complications is very low, only 0.7%.