重症吸入性肺炎合并ARDS患者行俯卧位机械通气时氧合、血流动力学及气道引流的研究

目的探讨俯卧位机械通气对重症吸入性肺炎合并急性呼吸窘迫综合征（ARDS）患者氧合、血流动力学及气道痰液引流的影响。方法纳入2010年1月至2012年6月宿迁市钟吾医院ICU收治的28例严重吸入性肺炎合并ARDS患者，镇静、肌松、持续俯卧位通气状态下监测初始仰卧位、俯卧位1h、俯卧位2h、恢复仰卧位2h各时间点的平均动脉压（MAP）、心率（HR）、中心静脉压（CVP）、脉搏血氧饱度（SpO2）、动脉血氧分压（PaO2）、二氧化碳分压（PaCO2），氧合指数（PaO2／FiO2）、痰液引流量等指标。结果与初始仰卧位比较，患者俯卧位1h、俯卧位2h时PaO2（85±12）mmHg和（97±10）mmHg比（65±11）mmHg]、PaO2／FiO2（150±37）mmHg和（158±50）mm如比（130±28）mmHg]明显升高（P〈0．05），且恢复仰卧位2h时持续存在PaO2（87±11）mmHg，Pa02／Fi02（150±52）mmHg，P〈0．05]，MAP、HR、CVP、SpO2差异无统计学意义（P〉0．05）。俯卧位2h时气道痰液引流量较初始仰卧位明显增加（15．3±2．0）mL比（8．1±1．1）mL，P〈0．05]，而俯卧位1h、恢复仰卧位2h痰液引流量与初始仰卧位时比较差异无统计学意义（9．1±1．0）mL和（8．3±1．2）mL比（8．1±1．1）mL，P〉0．05]。结论俯卧位通气可改善严重吸入性肺炎合并ARDS患者的氧合，且恢复仰卧位后氧合改善持续存在；可改善气道痰液引流，但恢复仰卧位后改善引流作用消失；俯卧位通气对血流动力学无明显影响。俯卧位通气可用于严重吸入性肺炎并ARDS的辅助治疗，需气道充分引流的患者可适当延长俯卧位通气时间。

Effects of Prone Position Ventilation on Oxygenation,Hemodynamics and Airway Drainage in Patients with Severe Aspiration Pneumonia with ARDS

Objective To investigate the effects of prone position ventilation on oxygenation, hemodynamics and airway drainage in patients with severe aspiration pneumonia with acute respiratory distress syndrome （ARDS）. Methods 28 patients with severe aspiration pneumonia with ARDS admitted between January 2010 and June 2012 were recruited in the study. They were ventilated in prone position with sedation and paralysis. Mean blood pressure （MAP） , heart rate （ HR ） , central venous pressure （CVP） , pulse oxygen saturation （SpO2 ）, arterial oxygen tension （PaO2 ）, carbon dioxide partial pressure （PaCO2 ）, oxygenation index （ PaO2/FiO2 ） and sputum drainage were recorded in the time points of initial supine position, prone position 1 h, prone position 2h, and return to supine position 2h. Results Compared with the time point of initial supine position, PaO2 and PaO2/FiO2 increased significantly after 1 and 2 hours in prone position PAO2：（85 ± 12）ram Hg and （97± 10）ram Hg vs. （65 ±11）mm Hg;PaO2/FiO2：（150± 37） mm Hg and （ 158± 50） mm Hg vs. （ 130 ± 28） mm Hg; all P 〈 0. 05 ]. The effects of oxygenation improving were persistent 2h after return to supine position PaO2 ： （87±11 ）mm Hg;PaO2/FiO2 ： （ 150± 52） mm Hg, P 〈 0. 05 ]. There was no significant difference in MAP, HR, CVP, or SpO2 during the study. Airway sputum drainage was signifieantly increased 2h after in prone position compared with that in initial supine position （ 15.3 ±2.0 ） mL vs. （ 8. 1± 1.1 ） mL, P 〈 0. 05 ]. Airway sputum drainage had no significant difference among I hafer prone position, 2h after return to supine position and the initial supine position （9. 1 ± 1.0） mL and （8. 3 ±1.2） mL vs. （ 8. 1 ± 1.1 ） mL, P 〉 0.05 ]. Conclusions Prone position ventilation can improve the oxygenation in patients with severe aspiration pneumonia with ARDS, and the effects of oxygenation improvement can be persistent till 2h after return to supine position. Prone position ventilation can improve sputum drainage without significant influence on hemodynamics, thus can be used as an adjuvant treatment for severe aspiration pneumonia with ARDS. The duration of prone position ventilation needs to be prolonged for patients with much airway secretion.