分析俯卧位通气对重度ARDS患者血流动力学及呼吸功能影响

Analysis of the effects of prone position ventilation on hemodynamics and respiratory function in patients with severe ARDS

目的:研究俯卧位通气对重度急性呼吸窘迫综合征(ARDS)患者血流动力学及呼吸功能的影响。方法:此次入选研究对象均为重度ARDS患者,共计38例,以方便抽取法实施分组,均分为对照组(19例)和观察组(19例)两组,前组实施常规仰卧通气治疗,后组实施俯卧位通气治疗,比较两组血流动力学以及动脉血氧分压(PaO 2)、二氧化碳分压(PaCO 2)、动脉氧合指数(PaO 2/FiO 2)等指标。结果:在平均动脉压(MAP)、中心静脉压(CVP)两项血流动力学指标的比较上,两组各时段数据比较,差异无统计学意义(P>0.05),在心率(HR)指标比较上,两组通气开始(T 1)、通气2 h(T 2)时段数据比较,差异无统计学意义(P>0.05),两组通气24 h(T 3)时段数据对比,差异有统计学意义(P<0.05);在PaO 2、PaCO 2、PaO 2/FiO 2三项指标的对比上,观察组T 2、T 3时段较之对照组显出明显优势,差异有统计学意义(P<0.05)。结论:在治疗重度ARDS患者的过程中采取俯卧位通气,对患者血流动力学的影响更轻微,其氧合指数也会得到显著改善,进一步增加呼吸顺应性,有效避免发生不必要的不良事件,具有推广价值。

Objective To analyze the effect of prone position ventilation on hemodynamics and respiratory function in patients with severe acute respiratory distress syndrome(ARDS).Method 38 patients with severe ARDS were enrolled in this study.They were divided into control group(19 cases)and observation group(19 cases)by convenient drawing.The former group was treated with routine supine ventilation while the latter group was treated with prone ventilation.The hemodynamics and arterial oxygen partial pressure(PaO 2),partial pressure of carbon dioxide(PaCO 2),arterial oxygenation index(PaO 2/FiO 2)and other indicators of the two groups were compared.Results In the comparison of MAP and CVP,there was no significant difference between the two groups(P>0.05).In the comparison of HR,there was no significant difference between the two groups(P>0.05).There was significant difference between the two groups(P<0.05).In the comparison of PaO 2,PaCO 2 and PaO 2/FiO 2,there was significant difference between the two groups,the control group showed significant advantage(P<0.05).Conclusion In the treatment of severe ARDS patients,prone position ventilation has less impact on hemodynamics,and its oxygenation index will be significantly improved.It can further increase respiratory compliance and effectively avoid unnecessary adverse events.