中国医师进修杂志
中國醫師進脩雜誌
중국의사진수잡지
CHINESE JOURNAL OF POSTGRADUATES OF MEDICINE
2010年
31期
23-25
,共3页
郭发良%杨秀洁%王桂秀%卜会驹%林小茂
郭髮良%楊秀潔%王桂秀%蔔會駒%林小茂
곽발량%양수길%왕계수%복회구%림소무
呼吸窘迫综合征,成人%通气机,机械%俯卧位%改良俯卧位
呼吸窘迫綜閤徵,成人%通氣機,機械%俯臥位%改良俯臥位
호흡군박종합정,성인%통기궤,궤계%부와위%개량부와위
Respiratory distress syndrome,adult%Ventilators,mechanical%Prone position%Reformative prone position
目的 探讨在机械通气的急性呼吸窘迫综合征(ARDS)患者中改良的俯卧位头高脚低倾斜30°机械通气方法,相比常规的俯卧位机械通气的优点.方法 选择行机械通气的ARDS患者44例,按随机数字表法分为俯卧位组和倾斜俯卧位组,每组22例.患者平时持续30°半卧位,每天进行俯卧位机械通气1次,每次4 h.分别记录两组患者在俯卧位机械通气前、中、后血流动力学及呼吸等指标的变化,并作统计学分析.结果 两种俯卧位机械通气后患者的氧合指数均有改善,两组间比较差异无统计学意义(P＞0.05).与倾斜俯卧位组比较,俯卧位组体位改变后出现肺静态顺应性下降[2h时(25.6±5.8)ml/cm H2O(1 cm H2O=0.098 kPa)比(37.2±20.5)ml/cm H2O],平均气道压上升[2 h时(18.5±3.9)cm H2O比(15.6±5.3)cm H2O],心率增快[2 h时(112.0±16.2)次/min比(102.0±11.3)次/min],平均动脉压下降[2 h时(86.0±6.7)mm Hg(1 mm Hg=0.133 kPa)比(93.5±7.5)mm Hg],中心静脉压上升[2 h时(15.5±3.3)cm H2O比(12.6±4.3)cm H2O];这些改变在俯卧位期间持续存在(P＜0.05),恢复30°半卧位后1 h消失.结论 改良的俯卧位通气,既有俯卧位改善氧合的作用,又可以避免俯卧位对肺静态顺应性和血流动力学的影响.
目的 探討在機械通氣的急性呼吸窘迫綜閤徵(ARDS)患者中改良的俯臥位頭高腳低傾斜30°機械通氣方法,相比常規的俯臥位機械通氣的優點.方法 選擇行機械通氣的ARDS患者44例,按隨機數字錶法分為俯臥位組和傾斜俯臥位組,每組22例.患者平時持續30°半臥位,每天進行俯臥位機械通氣1次,每次4 h.分彆記錄兩組患者在俯臥位機械通氣前、中、後血流動力學及呼吸等指標的變化,併作統計學分析.結果 兩種俯臥位機械通氣後患者的氧閤指數均有改善,兩組間比較差異無統計學意義(P＞0.05).與傾斜俯臥位組比較,俯臥位組體位改變後齣現肺靜態順應性下降[2h時(25.6±5.8)ml/cm H2O(1 cm H2O=0.098 kPa)比(37.2±20.5)ml/cm H2O],平均氣道壓上升[2 h時(18.5±3.9)cm H2O比(15.6±5.3)cm H2O],心率增快[2 h時(112.0±16.2)次/min比(102.0±11.3)次/min],平均動脈壓下降[2 h時(86.0±6.7)mm Hg(1 mm Hg=0.133 kPa)比(93.5±7.5)mm Hg],中心靜脈壓上升[2 h時(15.5±3.3)cm H2O比(12.6±4.3)cm H2O];這些改變在俯臥位期間持續存在(P＜0.05),恢複30°半臥位後1 h消失.結論 改良的俯臥位通氣,既有俯臥位改善氧閤的作用,又可以避免俯臥位對肺靜態順應性和血流動力學的影響.
목적 탐토재궤계통기적급성호흡군박종합정(ARDS)환자중개량적부와위두고각저경사30°궤계통기방법,상비상규적부와위궤계통기적우점.방법 선택행궤계통기적ARDS환자44례,안수궤수자표법분위부와위조화경사부와위조,매조22례.환자평시지속30°반와위,매천진행부와위궤계통기1차,매차4 h.분별기록량조환자재부와위궤계통기전、중、후혈류동역학급호흡등지표적변화,병작통계학분석.결과 량충부와위궤계통기후환자적양합지수균유개선,량조간비교차이무통계학의의(P＞0.05).여경사부와위조비교,부와위조체위개변후출현폐정태순응성하강[2h시(25.6±5.8)ml/cm H2O(1 cm H2O=0.098 kPa)비(37.2±20.5)ml/cm H2O],평균기도압상승[2 h시(18.5±3.9)cm H2O비(15.6±5.3)cm H2O],심솔증쾌[2 h시(112.0±16.2)차/min비(102.0±11.3)차/min],평균동맥압하강[2 h시(86.0±6.7)mm Hg(1 mm Hg=0.133 kPa)비(93.5±7.5)mm Hg],중심정맥압상승[2 h시(15.5±3.3)cm H2O비(12.6±4.3)cm H2O];저사개변재부와위기간지속존재(P＜0.05),회복30°반와위후1 h소실.결론 개량적부와위통기,기유부와위개선양합적작용,우가이피면부와위대폐정태순응성화혈류동역학적영향.
Objective To investigate the effect of reformative ventilation method (head-high leg-low 30°-declivate prone position ) in the ventilation of acute respiratory distress syndrome ( ARDS ) patients, and compared with normal prone position ventilation. Methods Forty-four patients of ARDS underwent ventilation were divided into prone position group (22 cases) and reformative prone position group (22cases) by random digits talle. Continuous 30° semireclining position was kept in normal time. The patients of the two groups underwent different prone position ventilation 4 hours every day,and indexes of hemodynamics and respiration before,during and after prone position ventilation were recorded and analyzed. Results After prone position ventilation, oxygenation index of two groups improved similarly (P ＞ 0.05 ). In prone position group, lung compliance decreased [2 h, ( 25.6 ± 5.8 ) ml/cm H2O ( 1 cm H2O = 0.098 kPa) vs. ( 37.2 ± 20.5 )ml/cm H2O] ,average airway pressure increased [2 h, ( 18.5 ± 3.9) cm H2O vs. ( 15.6 ± 5.3 )cm H2O] ,heart rate increased [2 h, ( 112.0 ± 16.2 ) beats/min vs. ( 102.0 ± 11.3 ) beats/min], mean arterial blood pressure decreased [2 h, (86.0 ± 6.7) mm Hg ( 1 mm Hg = 0.133 kPa) vs. (93.5 ± 7.5 ) mm Hg] ,central venous pressure increased[2 h, ( 15.5 ± 3.3 ) cm H2O vs. ( 12.6 ± 4.3 ) cm H2O]. These changes persistently existed during prone position ventilation (P ＜ 0.05 ),and they disappeared in 1 hour when recovered to 30 °semireclining position. Conclusion Reformative prone position ventilation not only has same effect on improving oxygenation index, but also obviates adverse effect on lung compliance and hemodynamics.
