改良俯卧位通气对急性呼吸窘迫综合征患者呼吸功能及预后的影响

Effect of Modified Prone Position Ventilation on Respiratory Function and Prognosis in Patients with Acute Respiratory Distress Syndrome

目的 探究改良俯卧位通气对急性呼吸窘迫综合征(ARDS)患者血流动力学、呼吸动力学及预后的影响。方法 前瞻性选取河南大学第一附属医院2020年3月至2022年6月收治的98例ARDS患者作为研究对象,通过随机数字表法分为A、B组。通过随机及前瞻性平行对照临床研究,评价不同通气方式在ARDS患者中的作用,其中A组52例接受改良式俯卧位通气,B组46例接受传统俯卧位通气。对比两组患者干预前、干预后(俯卧位通气4 h后)血流动力学[心率(HR)、平均动脉压、中心静脉压]、呼吸动力学指标[气道阻力、静态肺顺应性(Cst)]、氧合指数及腹腔压力的变化。比较两组患者不良事件发生情况,对所有患者进行3个月随访,比较两组患者病死率情况。结果 (1)A组机械通气时间低于B组,撤机成功率高于B组(P<0.05);(2)干预后,两组患者HR均较干预前上升,干预前后差值具有统计学意义(P<0.05);(3)干预后,两组Cst水平均较干预前上升且A组高于B组,干预前后差值具有统计学意义(P<0.05);(4)干预后,两组腹腔压力均较治疗前上升且A组低于B组,干预前后差值具有统计学意义(P<0.05);(5)A组不良事件总发生率[7.69%(4/52)]低于B组[23.91%(11/46)](P<0.05);(6)随访3个月结果显示,A组病死率[23.08%(12/52)]低于B组[43.48%(20/46)](P<0.05)。结论 改良俯卧位通气对ARDS血流动力学、呼吸动力学及相关指标均有显著的改善效果,不良事件的发生率较低且预后状况良好,值得临床参考借鉴。

Objective To investigate the effect of modified prone position ventilation on hemodynamics,respiratory dynamics and prognosis in patients with acute respiratory distress syndrome(ARDS).Methods Ninety-eight ARDS patients admitted to the First Affiliated Hospital Of Henan University from March 2020 to June 2022 were selected as the study objects and divided into group A and group B by random number table method.A randomized and prospective parallel controlled clinical study was conducted to evaluate the effects of different ventilation methods in ARDS patients.Among them,52 patients in group A received modified prone position ventilation and 46 patients in group B received traditional prone position ventilation.Hemodynamics[heart rate(HR),mean arterial pressure,and central venous pressure],respiratory dynamic indexes[airway resistance,static compliance(Cst)],oxygenation index and abdominal pressure were compared between the two groups before and after intervention.The incidence of adverse events was compared between the two groups.All patients were followed up for 3 months,and the mortality was compared between the two groups.Results(1)The mechanical ventilation time of group A was lower than that of group B,and the success rate of weaning was higher than that of group B(P<0.05).(2)After intervention,HR of patients in both groups increased compared with that before intervention,the difference before and after intervention was statistically significant(P<0.05).(3)After intervention,the level of Cst in the two groups was higher than that before intervention,and the level of Cst in group A was higher than that in group B,the difference before and after intervention was statistically significant(P<0.05).(4)After intervention,abdominal pressure of the two groups were increased compared with those before treatment,and group A was lower than in group B,the difference before and after intervention was statistically significant(P<0.05).(5)The total incidence of adverse events in group A(7.69%,4/52)was lower than that in group B(23.91%,11/46)(P<0.05).(6)After 3 months of follow-up,the mortality of group A(23.08%,12/52)was lower than that of group B(43.48%,20/46)(P<0.05).Conclusion The modified prone position ventilation can improve the hemodynamics,respiratory dynamics and related indexes of ARDS.The incidence of adverse events is low and the prognosis is good,which is worthy of clinical reference.