摘要
目的:观察不同病因所致急性呼吸窘迫综合征(ARDS)患者应用俯卧位通气(PPV)的临床效果及对血液动力学的影响。方法:选取44例ARDS患者,采取前瞻性对照研究方式,按照病因分为肺内源性组(23例)和肺外源性组(21例),给予俯卧位通气治疗;观察2组患者治疗前(P0)、治疗后1h(P1)、治疗后2h(P2)呼吸动力学指标(肺容积、Cst、PIP、Pplat)、血液动力学指标(MAP、CVP、HR、CI)、血气分析(Pa O_2、Pa CO_2、Pa O_2/Fi O_2、Sa O_2)及心、肾、凝血功能。结果:(1)应用PPV后1h、2h,2组患者肺容积、肺静态顺应性(Cst)均升高(均P<0.05);(2)肺外源性组P1、P2与P0比较,MAP、HR均下降明显(均P<0.05);肺内源性组P2与P0比较,MAP、HR均下降明显(均P<0.05);组间比较,P1时间点肺外源性组比肺内源性组MAP、HR均下降明显(均P<0.05);(3)肺内源性组P2时间点各指标优于P0(均P<0.05);肺外源性组P1、P2时间点各指标优于P0(均P<0.05);组间比较,P1时间点肺外源性组血气指标优于肺内源性组(P<0.05);(4)2组各时间点PT、APTT、D-二聚体、BNP、Cr、BUN指标比较差异无统计学意义(P>0.05)。结论:俯卧位通气可改善肺内/外源性ARDS患者氧合功能、血液动力学指标,肺外源性ARDS患者可较快改善患者氧合指数,提高回心血量;PPV对ARDS患者心、肾、凝血功能无明显影响。
Objective: To observe the clinical effect of prone position ventilation( PPV) in patients with acute respiratory distress syndrome( ARDS) with different causes and its influence on hemodynamics. Methods: 44 patients with ARDS were selected and prospectively controlled. The patients were divided into endogenous pulmonary group( 23 cases) and exogenous pulmonary group( 21 cases) according to different causes and both two groups were given PPV. Respiratory parameters( lung volume,Cst,PIP,Pplat),hemodynamic indexes( MAP,CVP,HR,CI),blood gas analysis( Pa O_2,Pa CO_2,Pa O_2/Fi O_2,Sa O_2),function of heart and kidney,and coagulation function indexes were observed before treatment( P0),1 h after treatment( P1),and 2 h after treatment( P2) in both two groups of patients. Results:(1) Pulmonary volume and lung static compliance( Cst) increased at P1 and P2 after PPV in both two groups( P < 0. 05).(2) In exogenous pulmonary group,MAP and HR decreased significantly at P1 and P2 as compared with those at P0( P < 0. 05),but in the endogenous pulmonary group,MAP and HR showed a significant decrease at P2( P < 0. 05). MAP and HR decreased significantly at P1 in the exogenous pulmonary group as compared with that in the endogenous pulmonary group( P < 0. 05).(3)Each index at P2 was superior to that at P0 in endogenous pulmonary group( P < 0. 05). Each index at P1 and P2 was superior to that at P0 in the exogenous pulmonary group( P < 0. 05). The blood gas index at P1 in the exogenous pulmonary group was superior to that in the endogenous pulmonary group( P < 0. 05).(4) There were no significant differences in PT,APTT,D-dimer,BNP,Cr and BUN between two groups at all time points( P > 0. 05). Conclusion: PPV can improve the oxygenation function and hemodynamic parameters of patients with pulmonary endogenous/exogenous ARDS. PPV can improve the oxygenation index and increase the return blood volume of patients with exogenous pulmonary ARDS. PPV had no effect on heart,kidney and coagulation function in patients with ARDS.
引文
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