俯卧位机械通气对重症吸入性肺炎患者呼吸功能和血流动力学的影响

Effects of Prone Position Ventilation on Respiratory Function and Hemodynamics in Patients with Severe Aspiration Pneumonia

目的:通过比较仰卧位机械通气(supine position ventilation,SPV)和俯卧位机械通气(prone position ventilation,PPV)对重症吸入性肺炎患者呼吸功能和血流动力学的影响,进一步探究俯卧位机械通气对重症吸入性肺炎患者的疗效,为合理的临床诊疗提供更多理论依据。方法:选取2018年1月-2019年12月就诊笔者医院重症医学科的174例重症吸入性肺炎患者作为研究对象,均实施机械通气治疗,按照随机数字表法分为SPV组(n=91,仰卧位)与PPV组(n=83,俯卧位),对两组治疗效果进行对比。结果:治疗前两组FiO2、PEEP、PaO2、PaCO2、SpO2及OI比较差异无统计学意义(P>0.05),治疗后第1、3天PPV组FiO2、PEEP均高于SPV组,而PaO2、SpO2、OI均低于SPV组,差异均有统计学意义(P<0.05),两组治疗后第5、7天FiO2、PEEP、PaO2、SpO2、OI比较差异均无统计学意义(P>0.05),治疗后两组PaCO2比较差异均无统计学意义(P>0.05)。治疗前两组HR、MAP及CVP比较差异无统计学意义(P>0.05),治疗后第1天PPV组HR高于SPV组,差异有统计学意义(P<0.05),治疗后第3、5、7天两组HR比较差异无统计学意义(P>0.05),治疗后两组MAP、CVP比较差异均无统计学意义(P>0.05)。结论:俯卧位机械通气能够迅速改善重症吸入性肺炎的呼吸功能且对血流动力学无明显影响,但远期疗效无明显优势。

Objective:By comparing the influences of supine position mechanical ventilation (SPV) and prone position mechanical ventilation (PPV) on the respiratory function and hemodynamics of patients with severe inhalation pneumonia,the efficacy of mechanical ventilation in prone position is further investigated in order to provide more theoretical basis for reasonable clinical diagnosis and treatment.Method:A total of 174 patients with severe aspiration pneumonia in the Department of Critical Care Medicine of the author’s hospital from January 2018 to December 2019 were selected as the research subjects.They were all treated with mechanical ventilation,according to the random number table method,patients were divided into the SPV group (n=91,supine position) and the PPV group (n=83,prone position),and the therapeutic effects of the two groups were compared.Result:There were no statistically significant differences in FiO2,PEEP,PaO2,PaCO2,SpO2 and OI between the two groups before treatment (P>0.05),on day 1 and 3 after treatment,FiO2 and PEEP in PPV group were all higher than those in SPV group,while PaO2,SpO2 and OI were all lower than those in SPV group,the differences were statistically significant (P<0.05),there were no statistically significant differences in FiO2,PEEP,PaO2,SpO2 and OI between the two groups on day 5 and 7 after treatment (P>0.05),and there were no statistically significant differences in PaCO2 between the two groups after treatment (P>0.05).There was no significant difference in HR,MAP and CVP between the two groups before treatment (P>0.05),HR in the PPV group was higher than that in the SPV group on day 1 after treatment,the difference was statistically significant (P<0.05),there was no statistically significant difference in HR between the two groups on day 3,5 and 7 after treatment (P>0.05),there were no statistically significant differences in MAP and CVP between the two groups after treatment (P>0.05).Conclusion:The prone position ventilation can quickly improve the respiratory function of severe aspiration pneumonia without significant effect on hemodynamics,but there is no significant advantage in long-term efficacy.