CAJ | 학술논문

目的：探讨俯卧位肺复张对改善重症肺部感染低氧血症患者氧合指数、肺内分流的作用及对血流动力学的影响。方法：选取本院2011年10月至2013年12月诊治的重症肺部感染低氧血症患者52例，采用随机数字表法分为两组，26例患者实施仰卧位肺复张为对照组，26例患者实施俯卧位肺复张为观察组，比较两组患者基础指标的改变情况、氧合指数与肺内分流状况、血流动力学指标的改变情况、不良反应情况。结果：治疗后，两组患者血氧饱和度、氧合指数均显著增加，而Qs／QT均显著降低。观察组患者血氧饱和度、氧合指数均明显高于对照组，观察组患者Qs／QT明显低于对照组，差异均有统计学意义（ P＜0．05）。肺复张时，两组患者中心静脉压、心脏排血指数、每博指数、全心舒张期末容积指数、全心射血分数均显著降低，而全身血管阻力均显著增加，差异均有统计学意义（ P＜0．05）。结论：俯卧位肺复张可明显改善重症肺部感染低氧血症患者的氧合指数，可有效减少肺内分流，对血流动力学的影响较轻，不良反应少且安全性高，值得临床推广使用。
목적：탐토부와위폐복장대개선중증폐부감염저양혈증환자양합지수、폐내분류적작용급대혈류동역학적영향。방법：선취본원2011년10월지2013년12월진치적중증폐부감염저양혈증환자52례，채용수궤수자표법분위량조，26례환자실시앙와위폐복장위대조조，26례환자실시부와위폐복장위관찰조，비교량조환자기출지표적개변정황、양합지수여폐내분류상황、혈류동역학지표적개변정황、불량반응정황。결과：치료후，량조환자혈양포화도、양합지수균현저증가，이Qs／QT균현저강저。관찰조환자혈양포화도、양합지수균명현고우대조조，관찰조환자Qs／QT명현저우대조조，차이균유통계학의의（ P＜0．05）。폐복장시，량조환자중심정맥압、심장배혈지수、매박지수、전심서장기말용적지수、전심사혈분수균현저강저，이전신혈관조력균현저증가，차이균유통계학의의（ P＜0．05）。결론：부와위폐복장가명현개선중증폐부감염저양혈증환자적양합지수，가유효감소폐내분류，대혈류동역학적영향교경，불량반응소차안전성고，치득림상추엄사용。
Objective:To investigate the influence of prone position lung recruitment on improvement of oxygenation index ,role of intrapulmonary shunt , hemodynamics in patients with severe pulmonary infection and hypoxemia .Method:52 patients with severe pulmonary infection and hypoxemia were selected in hospi-tal from Oct.2011 to Dec.2013, who were randomly divided into two groups .26 patients treated supine posi-tion lung recruitment as control group .26 patients treated prone position lung recruitment as observation group.Changes of basic indexes,oxygenation,intrapulmonary shunt situation ,hemodynamic parameters,ad-verse reaction were compared between two groups .Result:After treatment, SPO2 and oxygenation index in-creased significantly , while Qs/QT decreased significantly in two groups .SPO2 and oxygenation index in ob-servation group were significantly higher than control group .Qs/QT in observation group was significantly lower than control group.Differences were statistically significant(P<0.05).As lung recruitment, CVP,CI, SI, GEDVI,GEF decreased significantly , while SVRI increased significantly in two groups .Differences were statistically significant ( P<0.05) .Conclusion:Prone position lung recruitment can significantly improve oxy-genation index of patients with severe pulmonary infection and hypoxemia , which can effectively reduce in-trapulmonary shunt .Prone position lung recruitment has less influence on hemodynamics , which has less ad-verse reaction and high safety .It is worthy of clinical use .