中国危重病急救医学
中國危重病急救醫學
중국위중병급구의학
CHINESE CRITICAL CARE MEDICINE
2012年
10期
596-599
,共4页
王文欣%徐波%马胡赛%孟建斌
王文訢%徐波%馬鬍賽%孟建斌
왕문흔%서파%마호새%맹건빈
急性呼吸窘迫综合征%俯卧位%机械通气%肺复张术%动脉血气%呼吸力学
急性呼吸窘迫綜閤徵%俯臥位%機械通氣%肺複張術%動脈血氣%呼吸力學
급성호흡군박종합정%부와위%궤계통기%폐복장술%동맥혈기%호흡역학
Acute respiratory distress syndrome%Prone position%Mechanical ventilation%Recruitment maneuver%Arterial blood gas%Respiratory dynamics
目的 探讨俯卧位通气对高海拔地区肺复张术(RM)治疗无效急性呼吸窘迫综合征(ARDS)患者的治疗作用.方法 从海拔2260m的地区医院筛选RM治疗无效的41例ARDS患者[平均氧合指数( PaO2/FiO2)较RM前升高＜20％视为RM无效],依不同病因分为肺内源性ARDS组(ARDSp组)和肺外源性ARDS组(ARDSexp组),每组再按信封法随机分为俯卧位组和仰卧位组,即ARDSp俯卧位组(11例)、ARDSp仰卧位组(9例)、ARDSexp俯卧位组(10例)、ARDSexp仰卧位组(11例).在通气前及通气1、2、3、4h监测动脉血氧分压( PaO2)、PaO2/FiO2、静态顺应性(Cst)、气道阻力(Raw)的变化.结果 通气lh时,ARDSexp俯卧位组PaO2/FiO2( mm Hg,l mm Hg=0.133 kPa)即较通气前显著升高(157.4±40.6比129.3±48.7,P＜0.05),并随通气时间延长呈持续增高趋势,4h达峰值(219.1 ±41.1);且ARDSexp俯卧位组通气3h内PaO2/FiO2较其他3组显著增高,另3组间则差异无统计学意义.ARDSp俯卧位组、ARDSexp俯卧位组通气4h时PaO2/FiO2均较相应仰卧位组显著增高(208.8±39.7比127.4±47.1,219.1±41.1比124.9±50.8,均P＜0.05).4组通气前后Cst无显著改变,各组间差异也无统计学意义.ARDSp俯卧位组通气4h时Raw(cmH2O·L-1·s-1)较通气前显著降低(6.8±1.7比10.7±1.8,P＜0.05),且明显低于其他3组；其他3组各时间点Raw组内及组间比较差异均无统计学意义.结论 俯卧位通气作为ARDS机械通气重要策略之一,可以改善RM无效高原ARDS患者的氧合,为抢救患者赢得宝贵的时间.
目的 探討俯臥位通氣對高海拔地區肺複張術(RM)治療無效急性呼吸窘迫綜閤徵(ARDS)患者的治療作用.方法 從海拔2260m的地區醫院篩選RM治療無效的41例ARDS患者[平均氧閤指數( PaO2/FiO2)較RM前升高＜20％視為RM無效],依不同病因分為肺內源性ARDS組(ARDSp組)和肺外源性ARDS組(ARDSexp組),每組再按信封法隨機分為俯臥位組和仰臥位組,即ARDSp俯臥位組(11例)、ARDSp仰臥位組(9例)、ARDSexp俯臥位組(10例)、ARDSexp仰臥位組(11例).在通氣前及通氣1、2、3、4h鑑測動脈血氧分壓( PaO2)、PaO2/FiO2、靜態順應性(Cst)、氣道阻力(Raw)的變化.結果 通氣lh時,ARDSexp俯臥位組PaO2/FiO2( mm Hg,l mm Hg=0.133 kPa)即較通氣前顯著升高(157.4±40.6比129.3±48.7,P＜0.05),併隨通氣時間延長呈持續增高趨勢,4h達峰值(219.1 ±41.1);且ARDSexp俯臥位組通氣3h內PaO2/FiO2較其他3組顯著增高,另3組間則差異無統計學意義.ARDSp俯臥位組、ARDSexp俯臥位組通氣4h時PaO2/FiO2均較相應仰臥位組顯著增高(208.8±39.7比127.4±47.1,219.1±41.1比124.9±50.8,均P＜0.05).4組通氣前後Cst無顯著改變,各組間差異也無統計學意義.ARDSp俯臥位組通氣4h時Raw(cmH2O·L-1·s-1)較通氣前顯著降低(6.8±1.7比10.7±1.8,P＜0.05),且明顯低于其他3組；其他3組各時間點Raw組內及組間比較差異均無統計學意義.結論 俯臥位通氣作為ARDS機械通氣重要策略之一,可以改善RM無效高原ARDS患者的氧閤,為搶救患者贏得寶貴的時間.
목적 탐토부와위통기대고해발지구폐복장술(RM)치료무효급성호흡군박종합정(ARDS)환자적치료작용.방법 종해발2260m적지구의원사선RM치료무효적41례ARDS환자[평균양합지수( PaO2/FiO2)교RM전승고＜20％시위RM무효],의불동병인분위폐내원성ARDS조(ARDSp조)화폐외원성ARDS조(ARDSexp조),매조재안신봉법수궤분위부와위조화앙와위조,즉ARDSp부와위조(11례)、ARDSp앙와위조(9례)、ARDSexp부와위조(10례)、ARDSexp앙와위조(11례).재통기전급통기1、2、3、4h감측동맥혈양분압( PaO2)、PaO2/FiO2、정태순응성(Cst)、기도조력(Raw)적변화.결과 통기lh시,ARDSexp부와위조PaO2/FiO2( mm Hg,l mm Hg=0.133 kPa)즉교통기전현저승고(157.4±40.6비129.3±48.7,P＜0.05),병수통기시간연장정지속증고추세,4h체봉치(219.1 ±41.1);차ARDSexp부와위조통기3h내PaO2/FiO2교기타3조현저증고,령3조간칙차이무통계학의의.ARDSp부와위조、ARDSexp부와위조통기4h시PaO2/FiO2균교상응앙와위조현저증고(208.8±39.7비127.4±47.1,219.1±41.1비124.9±50.8,균P＜0.05).4조통기전후Cst무현저개변,각조간차이야무통계학의의.ARDSp부와위조통기4h시Raw(cmH2O·L-1·s-1)교통기전현저강저(6.8±1.7비10.7±1.8,P＜0.05),차명현저우기타3조；기타3조각시간점Raw조내급조간비교차이균무통계학의의.결론 부와위통기작위ARDS궤계통기중요책략지일,가이개선RM무효고원ARDS환자적양합,위창구환자영득보귀적시간.
Objective To assess the effect of prone position on the oxygenation of patients with acute respiratory distress syndrome (ARDS) after recruitment maneuvers (RM) failure at high altitudes.Methods Forty-one ARDS patients who were invalid for RM therapy at the altitude of 2260 metres area hospital were enrolled [ mean oxygenation index (PaO2/FiO2) increased than RM＜ 20％ considered as RM invalid ].All were divided into acute respiratory distress syndrome (ARDSp) and extra-acute respiratory distress syndrome (ARDSexp) based on different etiology,and each group was randomly divided into the supine and the prone position group,i.e.that ARDSp prone position group (n=11),ARDSp supine group (n=9),ARDSexp prone position group (n=10),and ARDSexp supine group (n =11 ).Before ventilation and 1,2,3,4 hours after ventilation,arterial partial pressure of oxygen (PaO2),PaO2/FiO2,static lung compliance (Cst),airway resistance (Raw) were monitored.Results One hour after ventilation in ARDSexp prone position group,PaO2/FiO2 (mm Hg,1 mm Hg =0.133 kPa ) was significantly higher than before ventilation (157.4 ± 40.6 vs.129.3 ±48.7,P＜0.05),and increased by ventilation time,peaked at 4 hours (219.1 ±41.1 ).Within 3 hours ventilation in ARDSexp prone position group,PaO2/FiO2 was significantly higher compared with the other three groups,and there were no significant differences among the other three groups.PaO2/FiO2 in ARDSp prone position group and ARDSexp prone position group at 4 hours of ventilation were significantly higher compared with the corresponding supine group (208.8 ± 39.7 vs.127.4 ± 47.1,219.1 ± 41.1 vs.124.9 ± 50.8,both P＜0.05 ).There was no statistically significant difference in Cst before and after ventilation,and there was no significant changes among the groups.Raw (cm H2O ·L-1 ·s-1) in ARDSp prone position group at 4 hours of ventilation were significantly reduced than before ventilation (6.8 ± 1.7 vs.10.7 ± 1.8,P＜0.05 ),and significantly lower than the other three groups.There was no statistically significant difference in RAW among other three groups at each time point.Conclusion Prone position can improve RM oxygenation invalided ARDS patients at high altitudes.
