摘要
目的:探讨俯卧位通气用于中重度急性呼吸窘迫综合征(ARDS)患者,临床救治的效果及对腹腔压力(IAP)产生的影响。方法:选取2018年4月至2019年4月,在本院救治的64例中重度ARDS患者分为两组,常规组行常规仰卧位通气治疗,俯卧位组行俯卧位通气治疗,观察患者氧合指数、IAP、气道平台压(Pplat)、Lac等监测指标变化情况及预后状况、不良事件发生情况。结果:经通气治疗后3 d、7d、14 d,常规组、俯卧位组氧合指数与治疗前比较均表现出显著性提高(F=11.846、25.246,P<0.05),且俯卧位组治疗后3 d、7d、14 d的氧合指数较常规组均显著更高(t=14.380、10.553、10.703,P<0.05);俯卧位组通气治疗后12 h的Pplat、Lac较常规组均显著更低,IAP显著更高(t=7.907、17.556、8.317,P<0.05);通气治疗后与常规组比较,俯卧位组平均呼吸机使用、带管、ICU救治及住院时间均显著更(t=4.387、6.887、3.621、6.545,P<0.05);俯卧位组治疗后不良事件总发生率为6.3%,较常规组的18.8%显著更低(χ2=4.010,P<0.05)。结论:中重度ARDS患者临床救治中行俯卧位通气,可有效提高患者氧合指数,患者IAP有轻度提高,但不会对血流动力学、腹腔灌注压造成明显影响,可有效改善患者预后,减少不良事件发生风险。
Objective:To evaluate the effect of prone position ventilation in the treatment of moderate and severe acute respiratory distress syndrome(ARDS)and its influence on abdominal pressure(IAP).Methods:64 patients with moderate and severe ARDS treated in our hospital from April 2018 to April 2019 were divided into two groups,routine ventilation in supine position,the patients in prone position group were treated with ventilation in prone position,to observe the changes of oxygenation index,IAP,plat,LAC,prognosis and adverse events.Results:On the 3rd,7th and 14th day after ventilation treatment,the oxygenation index of routine group and prone position group was significantly higher than that before treatment(F=11.846、25.246,P<0.05),the oxygenation index of the prone position group was significantly higher than that of the conventional group on the 3rd,7 th and 14th day after treatment(t=14.380、10.553、10.703,P<0.05);In the prone position group,12 hours after ventilation,the levels of plat and lac were significantly lower than those in the conventional group,and IAP was significantly higher(t=7.907、17.556、8.317,P<0.05);After ventilation treatment,compared with the routine group,the average ventilator use,tube,ICU treatment and hospitalization time in the prone position group were significantly shorter(t=4.387、6.887、3.621、6.545,P<0.05);The total incidence of adverse events in the prone position group was 6.3%,significantly lower than that in the conventional group(18.8%)(χ2=4.010,P<0.05).Conclusions:In the clinical treatment of moderate and severe ARDS patients,prone position ventilation was used,can effectively improve the oxygenation index of patients,IAP was slightly increased in patients,but there was no significant impact on hemodynamics and APP,can effectively improve the prognosis and reduce the risk of adverse events.
作者
陈超
胡春晖
张慧峰
牛京京
秦秉玉
邵换璋
CHEN Chao;HU Chunhui;ZHANG Huifeng;NIU Jingjing;QIN Bingyu;SHAO Changzhang(Department of Intensive Medicine,Henan People’s Hospital(Zhengzhou University People’s Hospital),Zhengzhou 450000,China)
出处
《心肺血管病杂志》
2020年第7期795-798,803,共5页
Journal of Cardiovascular and Pulmonary Diseases
基金
河南省医学科技攻关项目(2017T02056)。
关键词
急性呼吸窘迫综合征
俯卧位通气
腹腔压力
血流动力学
预后
Acute respiratory distress syndrome
Prone position ventilation
Abdominal pressure
Hemodynamics
Prognosis
