俯卧位通气在急性Stanford A型主动脉夹层术后急性呼吸窘迫综合征中的疗效

Efficacy of prone positioning ventilation in acute respiratory distress syndrome after acute Stanford type A aortic dissection surgery

目的探讨俯卧位通气在急性Stanford A型主动脉夹层(acute Stanford type A aortic dissection,STAAD)术后急性呼吸窘迫综合征(acute respiratory distress syndrome,ARDS)中的疗效。方法收集2019年11月—2021年9月厦门大学附属心血管病医院STAAD术后并发ARDS且行俯卧位通气患者的临床资料,整理俯卧位前后血气分析、呼吸力学和血流动力学指标,对预后和不良事件等数据进行统计学分析。结果共264例STAAD患者行外科手术治疗,术后并发ARDS并行俯卧位通气患者40例,其中男37例、女3岁,平均年龄(49.88±11.46)岁。与俯卧位通气前相比,俯卧位通气开始后4 h、12 h,俯卧位通气结束后2 h、6 h氧分压、氧合指数及末梢血氧饱和度均明显改善(P<0.05)。俯卧位通气结束后2 h,氧合指数<131.42 mm Hg提示患者可能需要二次或多次俯卧位通气。结论STAAD术后中重度ARDS患者采用俯卧位通气是一种安全有效的改善患者氧合的方法。

Objective To explore the efficacy of prone positioning ventilation in patients with acute respiratory distress syndrome(ARDS)after acute Stanford type A aortic dissection(STAAD)surgery.Methods From November 2019 to September 2021,patients with ARDS who was placed prone position after STAAD surgery in the Xiamen Cardiovascular Hospital of Xiamen University were collected.Data such as the changes of blood gas,respiratory mechanics and hemodynamic indexes before and after prone positioning,complications and prognosis were collected for statistical analysis.Results A total of 264 STAAD patients had surgical treatment,of whom 40 patients with postoperative ARDS were placed prone position.There were 37 males and 3 females with an average age of 49.88±11.46 years.The oxygen partial pressure,oxygenation index and peripheral blood oxygen saturation 4 hours and 12 hours after the prone positioning,and 2 hours and 6 hours after the end of the prone positioning were significantly improved compared with those before prone positioning ventilation(P<0.05).The oxygenation index 2 hours after the end of prone positioning which was less than 131.42 mm Hg,indicated that the patient might need ventilation two or more times of prone position.Conclusion Prone position ventilation for patients with moderate to severe ARDS after STAAD surgery is a safe and effective way to improve the oxygenation.