Objective:To explore the influence of supine position(SP) and prone position(PP) ventilation combined with vibration sputum (VS) on hemodynamics,oxygenation and respiratory mechanics in patients with acute respiratory distress syndrome (ARDS).Methods:A total of 60 cases of ARDS patients with mechanical ventilation were randomly divided into SP ventilation group and PP ventilation group,SP ventilation combined with VS(SP+ VS) group,and PP ventilation combined with VS(PP+ VS) group,15 cases in each group.Heart rate(HR),mean arterial pressure(MAP),central venous pressure(CVP),pulse oxygen saturation(SPO2),arterial blood co2 partial pressure(PaCO2),arterial blood oxygen partial pressure(PaO2),oxygenation index(PaO2/ FiO2),breathing rate (RR),the airway peak pressure(PIP),mean airway pressure (Pmean),static lung co mpliance(Cst),and nursing complications at 5 different time points:before change the position(T0),1 h (T1),2 h (T2),and 4 h (T3) after change the position [after the VS treatment in the(SP+VS) group and(PP+ VS) group],and 1h (T4) after converting of SP were observed.The arterial oxygen partial pressure change(PaO2)＞10 m mHg was used as the effective standard.Results:There was no influence of the 4 groups of patients on HR,MAP,CVP,RR,PaCO2,Pmean and Cst(P＞0.05) after the position changing.SPO2,PaO2,and PaO2/FiO2 increased to different extent,and the improvement effect of oxygenation state in the 4 groups showed(PP+VS)＞PP＞(SP+VS)＞SP.The difference between groups,(PP+VS) group and (SP+VS) group,PP group and SP group,was statistically significant (P＜0.05);while there was no difference between(PP+ VS) group and PP group,and (SP + VS) group and SP group(P＞0.05).Conclusions:Compared with PP ventilation and SP ventilation,PP ventilation combined with VS was better to improve the oxygenation of patients with ARDS.Patients could maintain a stable circular function in the treatment when taking this kind of body posture,with no obvious change in the breath,and no obvious adverse complications occurred.%[目的]探讨仰卧位和俯卧位通气联合振动排痰对急性呼吸窘迫综合征(ARDS)机械通气病人血流动力学、氧合、呼吸力学的影响.[方法]选取60例ARDS机械通气病人,随机分为仰卧位通气(SP组)、俯卧位通气(PP组)、仰卧位通气+联合振动排痰(SP+VS组)、俯卧位通气联合振动排痰(PP+ VS组),每组15例.观察体位改变前(T0)、体位改变后(SP+ VS组和PP+VS组在振动排痰治疗后)1 h (T1)、2 h(T2)、4 h(T3)及转复为仰卧位后1 h(T4)5个不同时间点心率(HR)、平均动脉压(MAP)、中心静脉压(CVP)、脉搏血氧饱和度(SPO2)、动脉血二氧化碳分压(PaCO2)、动脉血氧分压(PaO2)、氧合指数(PaO2/FiO2)、呼吸频率(RR)、气道峰压(PIP)、平均气道压(Pmean)、静态肺顺应性(Cst)及护理并发症.以不同治疗方案后动脉氧分压改变(APaO2)＞10 mmHg作为有效标准.[结果]4组病人体位改变后对HR、MAP、CVP、RR、PaCO2、Pmean、Cst无影响(P＞0.05).而SPO2、PaO2、PaO2/FiO2有不同程度升高,氧合状态改善效果依次为PP+VS组＞PP组＞SP+VS组＞SP组,且组间比较PP+ VS组与SP+ VS组、PP组与SP组差异有统计学意义(P＜0.05);PP+ VS组与PP组、SP+VS组与SP组比较差异无统计学意义(P＞0.05).[结论]俯卧位通气联合振动排痰较单纯俯卧位通气、仰卧位通气相比,更能改善ARDS病人的氧合,且该种体位治疗期间病人循环功能稳定,呼吸参数无明显改变,且无明显不良并发症发生.
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