早期俯卧位通气在主动脉夹层术后低氧血症患者中的应用

摘要

Objective To study the influence of early prone ventilation on severe hypoxemia (PaO2/FiO2<100) patient's respiratory and hemodynamic parameters after Stanford Type A aortic dissection operation.MethodsTo apply early prone ventilation in 9 postoperative hypoxemia patients with Stanford Type A aortic dissection and then compare the changes of respiratory and hemodynamic parameters in four time points.Results The patients' oxygen partial pressure (PaO2), oxygen index (OI) and static lung compliance (Clst) 30 minutes (T2), 2 hours (T3) and 1 hour after prone ventilation (T4) increased significantly comapared with those before the implementation (T1); while the respiratory index (RI) decreased significantly (P<0.05). The PaO2 after 1 h (T4) was significantly lower than that after 30 min (T2) and 2h (T3) (P<0.05). The systolic blood pressure (SAP) after 30 min (T2) increased significantly while the heart rate (HR) and the central venous pressure (CVP) showed no statistically significant differences. ConclusionThe early implementation of prone ventilation can improve the postoperative hypoxemia in patients with aortic dissection oxygenation and had no adverse effect on hemodynamics.%目的：探讨早期实施俯卧位通气对Stanford A型主动脉夹层术后严重低氧血症（PaO2/FiO2＜100）患者呼吸参数及血流动力学的影响。方法对9例Stanford A型主动脉夹层术后严重低氧血症患者早期实施俯卧位通气，对比四个时间点患者呼吸参数及血流动力学指标变化情况。结果俯卧位通气30min（T2）、2h （T3）、实施后1h（T4）患者氧分压（PaO2）、氧合指数（OI）、静态肺顺应性（Clst）较实施前（T1）均明显上升，呼吸指数（RI）下降，差异具有统计学意义（P＜0.05）。实施后1h（T4）患者PaO2较实施30min（T2）、2h（T3）时有所下降，差异具有统计学意义（P＜0.05）。实施后30min（T2）患者收缩压（SAP）较实施前（T1）有所升高，差异具有统计学意义，心率（HR）、中心静脉压（CVP）无统计学意义。结论早期实施俯卧位通气可以有效改善主动脉夹层术后低氧血症患者氧合状况，对血流动力学无不良影响。