CAJ | 학술논문

目的：探讨俯卧位通气下肺内/外源性急性呼吸窘迫综合征( ARDS)患者的疗效及预后。方法对36例ARDS患者按不同发病原因分为肺内源性组及肺外源性组。两组均实施俯卧位通气治疗,每次治疗时间均为4 h。分别记录两组患者通气前及通气后1 h、2 h、4 h时的气道峰压( Pip)、气道平台压( Pplat)、静态肺顺应性(Cst)、气道阻力(Raw)、平均动脉压(MAP)、心率(HR)、心指数(CI)等指标,并进行血气分析检查记录动脉血氧分压( PaO2)、氧合指数( PaO2/FiO2)、动脉血二氧化碳分压( PaCO2)、动脉血氧饱和度( SaO2)。结果肺内源性组患者俯卧位通气1 h、2 h后PaO2/FiO2、PaCO2、PaO2较通气前无明显改善( P>0．05),4 h较前有显著性改善(P<0．05)。肺外源性组1 h即开始改善(P<0．05),2 h较1 h改善更显著(P<0．05),4 h较2 h上述指标改善有所下降。肺外源性组患者各项氧合指标在2 h改善优于肺内源性组患者(P<0．05),在4 h与肺内源性组差异无显著性(P>0．05)。两组患者俯卧位通气后较前在Pip、Pplat、Cst、Raw、HR、MAP、CI等参数上的变化差异无显著性( P>0．05),肺外源性组与肺内源性组差异无显著性( P>0．05)。结论俯卧位通气可改善肺内/外源性ARDS患者的氧合状况。肺外源性ARDS俯卧位通气早期氧合改善效果优于肺内源性组,且较肺内源性组氧合改善迅速,但维持时间短。肺内源性组ARDS氧合改善较肺外源性所需时间长。俯卧位通气治疗对其呼吸力学以及血流动力学指标无显著影响。
목적：탐토부와위통기하폐내/외원성급성호흡군박종합정( ARDS)환자적료효급예후。방법대36례ARDS환자안불동발병원인분위폐내원성조급폐외원성조。량조균실시부와위통기치료,매차치료시간균위4 h。분별기록량조환자통기전급통기후1 h、2 h、4 h시적기도봉압( Pip)、기도평태압( Pplat)、정태폐순응성(Cst)、기도조력(Raw)、평균동맥압(MAP)、심솔(HR)、심지수(CI)등지표,병진행혈기분석검사기록동맥혈양분압( PaO2)、양합지수( PaO2/FiO2)、동맥혈이양화탄분압( PaCO2)、동맥혈양포화도( SaO2)。결과폐내원성조환자부와위통기1 h、2 h후PaO2/FiO2、PaCO2、PaO2교통기전무명현개선( P>0．05),4 h교전유현저성개선(P<0．05)。폐외원성조1 h즉개시개선(P<0．05),2 h교1 h개선경현저(P<0．05),4 h교2 h상술지표개선유소하강。폐외원성조환자각항양합지표재2 h개선우우폐내원성조환자(P<0．05),재4 h여폐내원성조차이무현저성(P>0．05)。량조환자부와위통기후교전재Pip、Pplat、Cst、Raw、HR、MAP、CI등삼수상적변화차이무현저성( P>0．05),폐외원성조여폐내원성조차이무현저성( P>0．05)。결론부와위통기가개선폐내/외원성ARDS환자적양합상황。폐외원성ARDS부와위통기조기양합개선효과우우폐내원성조,차교폐내원성조양합개선신속,단유지시간단。폐내원성조ARDS양합개선교폐외원성소수시간장。부와위통기치료대기호흡역학이급혈류동역학지표무현저영향。
Objective To investigate the efficacy of the prone position ventilation on pulmonary /extrapul-monary acute respiratory distress syndrome ( ARDS) and prognosis. Methods 36 ARDS patients were divided into the pulmonary group and the extra-pulmonary group according to different etiology. Both groups were implemented with prone position ventilation therapy for 4 hours. Their inspiration pressure ( Pip) , plateau pressure ( Pplat) , static pulmonary compliance ( Cst) , airway resistance ( Raw) , mean arterial pressure ( MAP) , heart rate ( HR) , cardiac index ( CI) and other indicators were recorded. At the same time, their arterial oxygen tension ( PaO2 ) , oxygenation index ( PaO2/FiO2 ) , arterial carbon dioxide partial pressure ( PaCO2 ) and arterial oxygen saturation ( SaO2 ) were also analyzed. Results There was no significant difference in PaO2/FiO2 , PaCO2 and PaO2 in the pulmonary group two hours after the treatment, but they showed a certain difference 4 houts after the treatment (P<0. 05). 1-hour af-ter the treatment, the related indexes improved significantly, and they reached the highest 2-hour after There was no obvious difference in Pip, Pplat, Cst, Raw, HR, MAP, CI and other parameters between the two groups before and after the treatment (P>0. 05). Conclusion The prone position can improve the oxygenation of pulmonary/extrapul-monary ARDS patients.