ARDS患者仰卧位通气与俯卧位通气的对比

目的通过ARDS患者仰卧位通气与俯卧位通气血流动力学指标和血气指标，探讨俯卧位通气在ARDS肺保护作用。方法对19例ARDS患者按机械通气时体位分两组，仰卧位通气组（11例）和俯卧位通气组（8例），分别检测机械通气开始时（0h时）、2h时、24h时的血流动力学及血气的改变。结果两组对改善血流动力学方面作用不大，两组间MBP、CVP差异无明显性（P〉0．05），而俯卧位通气对HR的改善在24h时较明显，与仰卧位通气比较差异有显著性（P〈0．05）。仰卧位通气与俯卧位通气均能较好改善PO2、PaO2／FiO2，俯卧位通气与仰卧位通气比较能更好的改善PO2、PaO2／FiO2，在24h时最明显。差异有显著性（P〈0．05）；两组对PCO2改善不显著。结论俯卧位通气较仰卧位通气能明显改善ARDS患者的氧合，对血流动力学改变不明显。俯卧位通气可能通过改善通气／血流比例失调来促进ARDS患者氧合，纠正缺氧。

Ventilation in omparison of supine position and prone position in patients with acute respiratory distress syndrome

Objective To compare supine position and prone position ventilation in patients with acute respiratory distress syndrome（ARDS） by the blood gas analysis and hemodynamic indices so as to explore the effect and mechanism of prone position ventilation on acute respiratory distress syndrome as a lung protective strategy. Method Nineteen patients were allocated to two groups , with one group （n = 11 ） receiving supine position ventilation, and the other group （n = 8 ） receiving prone position ventilation. Hemodynamic indices and the blood gas analysis were detected respectively in the 0, 2nd, 24th hour after the mechanical ventilation. Results Supine position and prone position ventilation could not ameliorate hemodynamic indices. There were no significant differences in MBP and CVP in the two groups （P 〉0. 05）. There were obvious amelioration to HR in the prone position ventilation at the 24th hour, compared with the supine position ventilation （P 〈0. 05 ）. Supine position and prone position ventilation could all ameliorate PO2 , PaO2/FiO2. The effects of the prone position ventilation were better than the supine position ventilation. Obvious amelioration in the prone position ventilation were at the 24th hour. There were significant differences in the two groups （ P 〈 0. 05 ）. The two groups could not ameliorate PCO2 obviously. Conclusion The prone position ventilation can ameliorate oxygenation in ARDS patient compared with the supine position ventilation, but can＇t ameliorate hemodynamie indices obviously. Prone position ventilation can stimulate oxygenation in ARDS patient so as to correct anoxia by ameliorating turbulence of ventilation/blood.