俯卧位通气治疗中重度急性呼吸窘迫综合征的临床疗效

目的探讨俯卧位通气治疗中重度ARDS的疗效和安全性。方法8例肺复张无效的中重度ARDS患者实施了俯卧位通气，比较俯卧位通气前、俯卧位2h、恢复仰卧位1h呼吸力学、血流动力学和动脉血气指标的变化，同时观察治疗的并发症。结果8例患者共进行俯卧位通气41例次，无严重并发症发生。与俯卧位前相比，俯卧位、恢复仰卧位时PaCO2、PA-a，DO2降低（q分别为5．769、3．380、3．611、3．528，P〈o．05），氧合指数（PaO2／FiO2）升高（q分别为4．683、3．690，P〈O．05），但恢复仰卧位时PaO2／FiO2较俯卧位时有所下降（q=3．577，P〈O．05）；俯卧位前后气道峰压、平均气道压、气道平台压、静态肺顺应性、中心静脉压、平均动脉压、pH值、多巴胺及去甲肾上腺素用量差异无统计学意义（F值分别为1．404、2．516、2．297、1．904、2．985、2．043、0．106、0．007、0．045，P值均〉0．05）。结论俯卧位通气能改善中重度ARDS的氧合水平，不影响呼吸力学及血流动力学，简便易行，安全有效。

Clinical efficacy of prone position ventilation in the treatment of moderate and severe acute respiratory distress syndrome

Objective To investigate the clinical efficacy and safety of prone position ventilation in the treatment of moderate and severe acute respiratory distress syndrome （ARDS）. Methods Eight patients with moderate and severe ARDS after recruitment maneuvers （RM） failure were ventilated on prone position. The changes in hemodynamic and respiratory dynamic variables, blood gases before prone position ventilation, two hour after prone position and one hour after resuming supine position were compared. Complications were observed in the course of the treatment. Results Eight patients were ventilated on prone position for 41 times. There were no Serious complications associated with prone position ventilation. After prone position and resuming supine position, partial pressure of carbon dioxide （PaCO2）, alveolar-arterial oxygen tension difference P~A~ DO2 ）] decreased and PaO2/FiO2 increased compared to those before prone position （ P d0.05）, but PaO2/FiO2 after resuming supine position is lower than that after prone position （ P ＂~0.05）. There were no significant difference in peak inspiratory pressure （Ppeak）, mean airway pressure （ Pmean）, plateau airway pressure （Pplat）, static pulmonary compliance （Cst）, central venous pressure （CVP）, mean arterial blood pressure （ MAP）, PH, dopamine and norepinephrine dosage before and after prone position （ F = 1. 404,2. 516, 2. 297, 1. 904, 2. 985, 2. 043,0. 106,0. 007,0. 045,all P 〉0.05）. Conclusions Prone position ventilation is safe and effective, which can improve the oxygenation of moderate and severe ARDS with little influence on hemodynamics and respiratory mechanics.