摘要
目的探讨俯卧位通气(PPV)对急性呼吸窘迫综合征(ARDS)患者的影响。方法纳入2017年1月1日至2017年12月31日兰州大学第一医院重症医学科接受PPV治疗的ARDS患者,比较患者PPV前后心率、呼吸力学、血气指标的变化情况,PPV前及PPV后第1~7 d患者吸入氧浓度、氧合指数、压疮及其他相关并发症的情况,并行亚组预后分析。结果共纳入ARDS患者28例,男21例,女7例,其中14例合并慢性阻塞性肺疾病(简称慢阻肺),28 d内死亡20例。与PPV前相比,PPV后气道峰压明显下降,气道平台压明显下降,PaO2明显上升而PaCO2并无明显变化,SaO2明显上升,肺顺应性明显改善,PPV前后患者心率、呼吸频率、分钟通气量、潮气量、呼气末正压变化差异无统计学意义。PPV前与PPV后第1 d、PPV后第1 d与PPV后第7 d相比,FiO2均明显下降,PaO2/FiO2均明显增加,压疮发生均明显上升。在整个PPV操作过程当中发生非计划性拔管13例,其中9例为胃管滑脱,2例为尿管滑脱,1例为气管导管滑脱,1例为深静脉导管滑脱。发生人工气道阻塞17例,低血压7例,心律失常3例,角膜炎4例。亚组分析中,单纯组与合并慢阻肺组相比,合并慢阻肺组患者年龄明显偏高,其他基线资料均无差异;两组患者的存活率差异无统计学意义。结论PPV能够明显改善患者的呼吸状况,尤其是患者氧合和呼吸力学指标,同时PPV可增加患者压疮等并发症的发生率,但对预后并无改善。
Objectives To investigate the effect of prone position ventilation(PPV)on patients with acute respiratory distress syndrome(ARDS).Methods Patients with ARDS who received PPV treatment in the this hospital were enrolled from January 1,2017 to December 31,2017.The changes in heart rate,respiratory mechanics and blood gas index before and after PPV in patients,the inhaled oxygen concentration(FiO2),oxygenation index(PaO2/FiO2),pressure sore and other related complications were observed and compared in patients before and after PPV.Results A total of 28 patients with ARDS were registered,including 21 males and 7 females.Fourteen patients were complicated with chronic obstructive pulmonary disease(COPD)and 20 were dead in 28 days.After PPV,the peak pressure and plateau pressure decreased significantly,PaO2 and SaO2 increased significantly,system compliance improved considerably but Pa CO2 did not change.There was no significant difference in the changes of heart reat,respiratory rate,minute volume,tidal volume and positive end-expiratory pressure between before and after PPV.FiO2 decreased significantly,PaO2/FiO2 increased significantly,and pressure sore increased significantly on day 1 post-PPV in comparison to pre-PPV and on day 7 postPPV in comparison to day 1 post-PPV.A total of 13 unplanned extubation occurred during the entire PPV procedure,9 of them were gastric tube slipping,2 were urethral catheter slipping,1 was tracheal tube slipping,and 1 was deep venous catheter slipping.There were 17 cases of artificial airway obstruction,7 cases of hypotension,3 cases of arrhythmia,and4 cases of keratitis.In the subgroup analysis,the age of the patients complicated with COPD was significantly higher,but there was no difference in additional baseline data and the survival rate.Conclusion PPV can significantly improve the patient’s respiratory status,especially oxygenation and respiratory mechanics,but PPV can increase the incidence of complications such as pressure sore,and PPV does not improve the prognosis.
作者
岳伟岗
张莹
蒋由飞
袁鹏
尹瑞元
冯鑫
朱磊
郭鸿
尹超
张磊
李斌
张志刚
YUE Weigang;ZHANG Yin;JIANG Youfei;YUAN Peng;YIN Ruiyuan;FENG Xin;ZHU Lei;GUO Hong;YIN Chao;ZHANG Lei;LI Bin;ZHANG Zhigang(Department of Intensive Medicine,The First Hospital of Lanzhou University,Lanzhou,Gansu 730000,P.R.China)
出处
《中国呼吸与危重监护杂志》
CAS
CSCD
北大核心
2019年第6期532-536,共5页
Chinese Journal of Respiratory and Critical Care Medicine
关键词
急性呼吸窘迫综合征
呼吸衰竭
俯卧位通气
呼吸力学
Acute respiratory distress syndrome
Respiratory failure
Prone position ventilation
Respiratory mechanics