首页> 中文期刊>中国医学装备 >俯卧位机械通气治疗肺内外源性急性呼吸窘迫综合征的比较研究

俯卧位机械通气治疗肺内外源性急性呼吸窘迫综合征的比较研究

     

摘要

目的:探讨俯卧位机械通气对肺内外源性急性呼吸窘迫综合征(ARDS)的治疗作用。方法:选取60例ARDS患者,按ARDS病因不同分为肺内源性ARDS组(ARDSp)和肺外源性ARDS组(ARDSexp),每组30例。两组患者均早期予以俯卧位机械通气治疗,记录仰卧位及俯卧位2 h,4 h和6 h的动脉血氧分压(PaO2),吸入氧浓度(FiO2)、氧合指数(PaO2/FiO2)、胸肺顺应性(Cst)以及气道阻力(Raw),并采用澳大利亚USCOM监护仪进行连续心功能监测。结果:通气2 h时, ARDSexp组PaO2/FiO2即较通气前显著升高,4 h达峰值;且ARDSexp组通气3 h内PaO2/FiO2较其他时间点及ARDSp组显著增高,其余组间则差异无统计学意义。ARDSp组和ARDSexp组通气4 h时PaO2/FiO2均较相应仰卧位显著增高。ARDSp组通气4 h时Raw较通气前显著降低,且明显低于其他时间点。结论:无论是ARDSp组还是ARDSexp组俯卧位机械通气均能显著改善氧合等指标,同时对患者血流动力学各项指标影响很小,是患者早期支持治疗的重要而有效的手段。%Objective:To discuss what impact prone position ventilation (PPV) plays in treatment of acute respiratory distress syndrom (ARDS)originating from pulmonary disease(ARDSp) and extra-pulmonary disease(ARDSexp).Methods: Retrospective case-control cohorts study. Sixty patients with ARDS were included, were classified two groups which were originated from pulmonary disease(n=30) and extra-pulmonary disease(n=30), they were ventilated in PPV. And oxygenation of 0,2,4, and 6 hours in PPV, static compliance(Cst), airway resistance(Raw) of were evaluated. The Ultrasonic Cardiac Output Monitor was applied to monitor the cardiac function.Results:At 2 hours after ventilation in ARDSexp group, PaO2/FiO2 have been improved significantly. The longer duration of PPV seemed to be associated with continuous improvement and peaks at 4 hours. In ARDSexp group PaO2/FiO2 after ventilation at 3 hours exceeds the other groups. At 4 hours after ventilation, PaO2/FiO2 of both ARDSp and ARDSexp groups of PPV have been improved than that of supine position. After ventilation for 4 hours, the RAW of ARDSp decreases dramatically and considerably below the other groups.Conclusion: PPV was a safe and effective maneuver for improving oxygenation in patients with ARDSp and ARDSexp. Both ARDSp and ARDSexp clearly appear to benefit from PPV, particularly in ARDSexp group. PPV aslo influenced haemodynamics in patients rarely.

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