中国小儿急救医学
中國小兒急救醫學
중국소인급구의학
CHINESE PEDIATRIC EMERGENCY MEDICINE
2011年
3期
230-232
,共3页
俯卧位%机械通气%氧合%肺力学%婴儿,新生
俯臥位%機械通氣%氧閤%肺力學%嬰兒,新生
부와위%궤계통기%양합%폐역학%영인,신생
Prone positioning%Mechanical ventilation%Oxygenation%Lung mechanics%Infant,newborn
目的 研究俯卧位对机械通气新生儿氧合和肺力学的影响.方法 研究对象为2008年5月至2009年2月上海市儿童医院NICU收治的机械通气治疗的新生儿20例,采取交叉设计的方法随机分为仰卧位-俯卧位组和俯卧位-仰卧位组,每组10例.分别采取仰卧位→俯卧位各3h和俯卧位→仰卧位各3h,共6h,记录并分析患儿呼吸机参数、动脉血气和肺力学的改变.结果 在呼吸机参数改变无统计学意义的情况下,机械通气新生儿随机选取初始体位,进行自身对照,俯卧位3h的PaO2较仰卧位3h高,差异有统计学意义[(74.50±15.37)mm Hg vs (67.60±13.66)mm Hg(1mm Hg=0.133kPa),P<0.05];俯卧位3h的氧合指数较仰卧位高,差异有统计学意义[(201.86±55.96)mm Hg vs (184.38±63.58)mm Hg,P<0.05];60%(12/20)患儿俯卧位时OI高于仰卧位时,且平均升高17mm Hg.俯卧位3h的分钟通气量、潮气量和肺动态顺应性与仰卧位3h相比有改善,差异有统计学意义(P=0.011,0.020,0.045);俯卧位时气道阻力下降,但同仰卧位相比差异无统计学意义(P=0.422).结论 机械通气新生儿采取俯卧位时较传统仰卧位相比,可改善氧合、提高PaO2和氧合指数,并可增加分钟通气量和潮气量,改善肺动态顺应性.
目的 研究俯臥位對機械通氣新生兒氧閤和肺力學的影響.方法 研究對象為2008年5月至2009年2月上海市兒童醫院NICU收治的機械通氣治療的新生兒20例,採取交扠設計的方法隨機分為仰臥位-俯臥位組和俯臥位-仰臥位組,每組10例.分彆採取仰臥位→俯臥位各3h和俯臥位→仰臥位各3h,共6h,記錄併分析患兒呼吸機參數、動脈血氣和肺力學的改變.結果 在呼吸機參數改變無統計學意義的情況下,機械通氣新生兒隨機選取初始體位,進行自身對照,俯臥位3h的PaO2較仰臥位3h高,差異有統計學意義[(74.50±15.37)mm Hg vs (67.60±13.66)mm Hg(1mm Hg=0.133kPa),P<0.05];俯臥位3h的氧閤指數較仰臥位高,差異有統計學意義[(201.86±55.96)mm Hg vs (184.38±63.58)mm Hg,P<0.05];60%(12/20)患兒俯臥位時OI高于仰臥位時,且平均升高17mm Hg.俯臥位3h的分鐘通氣量、潮氣量和肺動態順應性與仰臥位3h相比有改善,差異有統計學意義(P=0.011,0.020,0.045);俯臥位時氣道阻力下降,但同仰臥位相比差異無統計學意義(P=0.422).結論 機械通氣新生兒採取俯臥位時較傳統仰臥位相比,可改善氧閤、提高PaO2和氧閤指數,併可增加分鐘通氣量和潮氣量,改善肺動態順應性.
목적 연구부와위대궤계통기신생인양합화폐역학적영향.방법 연구대상위2008년5월지2009년2월상해시인동의원NICU수치적궤계통기치료적신생인20례,채취교차설계적방법수궤분위앙와위-부와위조화부와위-앙와위조,매조10례.분별채취앙와위→부와위각3h화부와위→앙와위각3h,공6h,기록병분석환인호흡궤삼수、동맥혈기화폐역학적개변.결과 재호흡궤삼수개변무통계학의의적정황하,궤계통기신생인수궤선취초시체위,진행자신대조,부와위3h적PaO2교앙와위3h고,차이유통계학의의[(74.50±15.37)mm Hg vs (67.60±13.66)mm Hg(1mm Hg=0.133kPa),P<0.05];부와위3h적양합지수교앙와위고,차이유통계학의의[(201.86±55.96)mm Hg vs (184.38±63.58)mm Hg,P<0.05];60%(12/20)환인부와위시OI고우앙와위시,차평균승고17mm Hg.부와위3h적분종통기량、조기량화폐동태순응성여앙와위3h상비유개선,차이유통계학의의(P=0.011,0.020,0.045);부와위시기도조력하강,단동앙와위상비차이무통계학의의(P=0.422).결론 궤계통기신생인채취부와위시교전통앙와위상비,가개선양합、제고PaO2화양합지수,병가증가분종통기량화조기량,개선폐동태순응성.
Objective To investigate the effects of prone positioning on oxygenation and lung mechanics in neonates with mechanical ventilation.Methods Twenty cases of neonates,selected from Shanghai Children′s Hospital(from May 2008 to Feb 2009),were randomized to supine-prone position group (n=10) and prone-supine position group (n=10) using a crossover design.During 6h,these neonates were placed in the supine position for 3h then in the prone position for 3h or in reversed order.The ventilator parameters,results of arterial blood gas and the lung mechanics were recorded.Results Without obvious changes of ventilator parameters,PaO2 improved significantly when the incubated neonates were placed in the prone position for 3h compared to supine [(74.50±15.37)mm Hg vs (67.60±13.66)mm Hg,1mm Hg=0.133kPa,P<0.05).Similarly,oxygenation index of prone positioning for 3h was (201.86±55.96)mm Hg,which was higher than that of (184.38±63.58)mm Hg,the value of supine positioning for 3 h.There were significant differences (P<0.05).Our results showed that 60% (12/20) of the neonates responded to prone positioning,with oxysenation index increasing as much as 17mm Hg on average.Improvement in minute volume,tidal volume and dynamic compliance of the lung were achieved after prone positioning for 3h (P=0.011,0.020,0.045).The airway resistance did not decrease significantly (P=0.422),but the average decreased in the prone position.Conclusion Oxygenation and the lung mechanics are improved significantly in the neonates with prone position compared with supine position.
