俯卧位通气对急性呼吸窘迫综合征患者氧合能力及血流动力学的影响

摘要

目的观察俯卧位通气对急性呼吸窘迫综合征(acute respiratory distress syndrome,ARDS)患者氧合能力及血流动力学的影响.方法选取2014年1月至2016年12月本院101例ARDS患者作为研究对象,在一定镇静剂和肌肉松弛药作用下进行俯卧位通气,分别检测记录患者俯卧位通气前、俯卧位通气1小时、俯卧位通气2小时、仰卧位通气1小时、仰卧位通气2小时5个时间点的氧合能力[动脉血氧分压(arterial partial pressure of oxygen,PaO2)、动脉血二氧化碳分压、PaO2/吸入氧浓度(fraction of inspiration O2,FiO2)]及血流动力学指标(心排血量、每搏量、每搏量变异率)变化情况.结果俯卧位通气1小时和俯卧位通气2小时,PaO2、PaO2/FiO2均明显高于俯卧位通气前(P<0.05),至调整为仰卧位通气1小时仍可见明显的改善效应(P<0.05).由仰卧位变为俯卧位和俯卧位调整为仰卧位时,各时间点的血流动力学相关指标并未发生显著变化(P>0.05).结论俯卧位通气2小时内可显著改善ARDS患者的氧合能力,且对血流动力学无显著影响.%Objective To explore the effects of ventilation in prone positionon oxygenation capacity and hemodynamic in patients with acute respiratory distress syndrome (ARDS). Method 101 patients with ARDS were selected from January 2014 to December 2016 as the research objects, to action ventilation in prone position under certain sedatives and nondepolarizing, the oxygenation capacity [arterial partial pressure of oxygen (PaO2), partial pressure of carbon dioxide, PaO2/raction of inspiration O2 (FiO2)] and hemodynamic parameters (cardiac output, stroke volume and stroke volume variation) were recorded before prone position ventilation and prone position ventilation 1h, prone position ventilation 2h, supine position ventilation 1h and supine position ventilation 2h. Result At prone position ventilation 1h and prone position ventilation 2h, the PaO2 and PaO2/FiO2 were significantly higher than before prone position ventilation (P<0.05), and there was still a marked improvement effect in supine position ventilation 1h (P<0.05). From supine position to prone position and then to supine position, hemodynamic indexes at each time point did not changed significantly (P>0.05). Conclusion Ventilation in prone position within 2h can significantly improve oxygenation capacity in patients with ARDS, and with little influence on hemodynamics.