不同俯卧位联合反特伦德伦伯格卧位方案对ARDS患者肺通气功能及呼吸力学的影响

Effects of Different Prone Position Combined with Reverse Trendelenburg Position on Pulmonary Ventilation Function and Respiratory Mechanics in Acute Respiratory Distress Syndrome Patients

【目的】探讨不同俯卧位联合反特伦德伦伯格卧位对急性呼吸窘迫综合征(Acute respiratory distress syndrome,ARDS)患者肺通气功能及呼吸力学的影响。【方法】选取2018年2月至2020年3月在商洛市中心医院行机械通气的96例ARDS患者,采用随机数字表法分为A组、B组、C组,A组采用俯卧位2 h后改为反特伦德伦伯格卧位通气2 h;B组采用俯卧位通气2 h后俯卧位联合反特伦德伦伯格卧位通气2 h;C组采用俯卧位通气联合反特伦德伦伯格卧位2 h,然后单独采用俯卧位通气2 h。比较三组患者的肺通气功能及呼吸系统的静态顺应性(static compliance of the total respiratory system,Ctot)、胸廓静态顺应性(static compliance of the chest wall,Ccw)情况。【结果】三组患者干预前氧合指数(PaO_(2)/FiO_(2))、动脉二氧化碳分压(PaCO_(2))比较,差异均无统计学意义(P>0.05);干预2 h后,C组PaO_(2)/FiO_(2)高于A组(P<0.05),PaCO_(2)低于A组、B组(P<0.05);干预4 h后,三组PaO_(2)/FiO_(2)比较,差异均有统计学意义(P<0.05),但三组PaCO_(2)比较,差异无统计学意义(P>0.05)。三组患者干预前Ctot、Ccw比较,差异均无统计学意义(P>0.05);干预2 h后,C组Ccw高于A组、B组(P<0.05);干预4 h后,C组Ccw显著高于A组(P<0.05)。【结论】俯卧位通气前采用俯卧位联合反特伦德伦伯格卧位可缩短ARDS患者PaO_(2)/FiO_(2)恢复时间,增加Ccw,在护理过程中应综合考虑患者气道及呼吸管理需求,选择合适体位。

【Objective】To observe the effects of different prone positions combined with reverse Trendelenburg position on pulmonary ventilation function and respiratory mechanics in acute respiratory distress syndrome(ARDS)patients.【Methods】A total of 96 patients with acute respiratory distress syndrome who underwent mechanical ventilation in Shangluo Central Hospital from February 2018 to March 2020 were enrolled in the study.Patients were divided into four groups by random digital table method.The A group was ventilated by routine prone position for 2 hours followed by reverse Trendelenburg supine position ventilation for another 2 hours;The B group received prone position ventilation for 2 hours,then prone position combined with reverse Trendelenburg supine position for 2 hours;The C group was ventilated by conventional prone position ventilation combined with reverse Trendelenburg supine position for 2 hours,follow by prone ventilation alone for 2 h.The pulmonary ventilation function,static compliance of the total respiratory system(Ctot)and static compliance of the chest wall(Ccw)of the three groups were compared.【Results】Before the intervention,there was no significant difference in PaO_(2)/FiO_(2) and PaCO_(2) among the three groups(P>0.05).After 2 hours of intervention,PaO_(2)/FiO_(2) in group C was higher than that in group A(P<0.05),and PaCO_(2) in group C was lower than that in group A and group B(P<0.05).After 4 h of intervention,PaO_(2)/FiO_(2) among three groups were statistically different(P<0.05),however,PaCO_(2) was no statistically significant among the three groups(P>0.05).There were no significant differences in both Ctot and Ccw among the three groups before intervention(P>0.05).After 2 hours of intervention,the Ccw of group C was higher than that of group A and B(P<0.05);After 4 hours of intervention,the Ccw of group C was significantly higher than that of group A and B(P<0.05).【Conclusion】Combined prone position with reverse Trendelenburg supine position can shorten the PaO_(2)/FiO_(2) recovery time and increase Ccw.In the nursing process,the patients'airway and respiratory management needs should be considered comprehensively,therefore a reasonable posture should be selected.