俯卧位通气在ARDS中的临床应用价值探讨

目的探讨俯卧位通气（PPV）在急性呼吸窘迫综合征（ARDS）的临床应用价值。方法选取2006—05—2011—05江苏泗洪分金亭医院ICU收治的36例急性呼吸窘迫综合征患者．随机分为仰卧位组和俯卧位通气，两组均采用肺保护性通气策略，分别监测两组患者在充分镇静情况下初始仰卧位及俯卧位通气1h、2h、4h、6h后患者的动脉血氧分压（Pa02）、氧合指数（PaO。／Fi02）、pH值、动脉血二氧化碳分压（PaC02）、Sp02、心率（HR）、平均动脉压（MAP）、中心静脉压（CVP）等呼吸循环指标。结果俯卧位组在动脉血氧分压（PaOz）、氧合指数（PaO2／FiO2）、SpO2等呼吸指标方面较对照组明显改善（P〈0．05），机械通气时间、住院时间和住院期问死亡率明显降低（P〈0．05）。而心率（HR）、平均动脉压（MAP）、中心静脉压（CVP）等循环指标较对照组无明显差异（P〉0．05）。结论俯卧位通气可明显改善ARDS患者的氧合状况，而对血流动力学影响不明显。

Study on value and clinical application of prone position ventilation in acute respiratory distress syndrome

Objective To investigate the value and clinical application of prone position ventilation in acute respiratory distress syndrome（ARDS）. Methods 36 cases of ARDS treated in our hospital from 2006 05 to 2010 06 months were randomly divided into two groups,one group was placed in the supine position with lung protective ventilation strategy as a control group,another group using the prone position of lung protective ventilation strategy for treat- ment of group. Monitoring of patients in the 2 groups were adequate sedation cases initial supine and prone position ventilation in 1 h,2 h, 4 h, 6 h in patients with arterial partial pressure of oxygen（PaP2 ） ,oxygenation index（ PaO2/ FiO2 ）, pH, arterial partial pressure of carbon dioxide （PaCOz, SpO2 ）, heart rate （HR）, average arterial pressure （MAP） ,central venous pressure（CVP） and other respiratory cycle index. Results The prone position group partial pressure of oxygen in arterial blood （PaO2）, oxygenation index（PaO2/FiO2 ）, SpO2 and other respiratory indicators were improved significantly than the control group（P〈0.05 ）, mechanical ventilation time, duration of hospitalization and mortality during hospitalization were significantly reduced（P〈0.05）. While the pH value,arterial partial pres- sure of carbon dioxide（ PaCO2 ）, heart rate（ HR}, mean arterial pressure（MAP）, central venous pressure（CVP）, respiratory and circulatory indices compared with the control group had no significant difference（P〉0.05）. Conclusion The prone position ventilation can significantly improve the ARDS patient＇s oxygenation status,and restoring after oxygenation improved persistence. Prone position ventilation in acute respiratory distress syndrome（ARDS） therapy has good clinical application value.