俯卧位通气在心脏病患者术后低氧血症中的治疗研究

Prone Position Ventilation in Patients with Hypoxemia after Cardiac Surgery.

目的明确俯卧位通气是否显著改善成人心脏病患者体外循环(CPB)术后的低氧血症。方法回顾2019年1~12月在笔者科室经CPB行心脏病手术的患者251例(年龄≥18岁),对术后氧合指数(P/F ratio)≤200mmHg并行俯卧位通气的18例患者进行统计分析。比较患者在俯卧位通气前、俯卧位后1、24和48h的心率(HR)、平均动脉压(MAP)、血氧饱和度(SpO 2)、P/F ratio、肺动态顺应性和动脉血二氧化碳分压(PCO 2),统计患者总机械通气时间、ICU天数、二次气管插管率和术后并发症等。结果患者平均年龄为51.1±10.9岁,机械通气时间中位数为4天,总俯卧位时间中位数为26h。俯卧位前后各时间点,患者HR、MAP和PCO 2值比较差异无统计学意义(P>0.05)。与俯卧位前比较,患者俯卧位后24和48h的SpO 2显著升高(98.6±0.5、98.7±0.7 vs 93.9±5.7,P<0.05);与俯卧位后1h比较,患者俯卧位后48h的SpO 2显著升高(98.7±0.7 vs 97.4±1.5,P<0.05);与俯卧位前比较,患者俯卧位后1、24和48h的P/F ratio显著升高(198.6±51.3、251.0±53.6、256.9±57.7 vs 139.4±43.2,P<0.05),与俯卧位后1h比较,患者俯卧位后24和48h的P/F ratio显著升高(251.0±53.6、256.9±57.7 vs 198.6±51.3,P<0.05);与俯卧位前比较,患者肺动态顺应性在俯卧位后24和48h显著升高(46.0±6.5、47.1±6.1 vs 41.1±6.1,P<0.05)。结论俯卧位通气改善成人心脏病术后患者的低氧血症,可能促进患者早期快速康复。

Objective To evaluate whether prone position ventilation can improve postoperative hypoxemia in adult patients with heart disease.Methods From January 2019 to December 2019,251 adult patients(age≥18 years old)who underwent CPB for heart disease were reviewed,among them,18 patients with P/F ratio≤200mmHg and prone position ventilation were statistically analyzed.The heart rate(HR),mean arterial pressure(MAP),SpO 2,P/F ratio,pulmonary dynamic compliance and PCO 2 were compared before ventilation in prone position,1,24 and 48h after ventilation in prone position.The total mechanical ventilation time,ICU days,the rate of re-intubation and postoperative complications were analyzed.Results The mean age of the patients was 51.1±10.9 years old,and the median time of mechanical ventilation and prone position were 4 days and 26 hours,respectively.HR,MAP and PCO 2 were not significantly different before and after prone position(P>0.05).The SpO 2 of the patients was significantly higher at 24 and 48h after prone position than that before prone position(98.6±0.5,98.7±0.7 vs 93.9±5.7,P<0.05).The SpO 2 of the patients was significantly higher at 48h after prone position than that at 1h after prone position(98.7±0.7 vs 97.4±1.5,P<0.05).The P/F ratio of the patients increased significantly at 1h,24 and 48h after prone position compared with that before prone position(198.6±51.3,251.0±53.6,256.9±57.7 vs 139.4±43.2,P<0.05),and the P/F ratio was significantly higher at 24 and 48h after prone position compared with that at 1h after prone position(251.0±53.6,256.9±57.7 vs 198.6±51.3,P<0.05).The pulmonary dynamic compliance was significantly higher at 24h and 48h after prone position compared with that before prone position(46.0±6.5,47.1±6.1 vs 41.1±6.1,P<0.05).Conclusion Prone position ventilation can improve the hypoxemia in adult patients after cardiac surgery,which may promote the early and enhanced recovery of these patients.