Effects of prone position ventilation on respiratory mechanics, oxygenation parameters and hemodynamics in patients with ARDS
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摘要: 目的 探讨俯卧位通气对急性呼吸窘迫综合征(acute respiratory distress syndrome，ARDS)患者呼吸力学、氧合参数及血流动力学指标的影响。方法 选择2018年1月—2022年12月我院收治的100例ARDS患者，回顾性收集患者临床资料，按照通气方式将其分为观察组(俯卧位通气，n=62)和对照组(仰卧位通气，n=38)。对比2组治疗前后呼吸力学指标(肺顺应性、气道平均压、气道平台压)、通气前(T0)及通气12 h(T1)时氧合参数[动脉血氧分压(PaO2)、动脉氧合指数(PaO2/FiO2)] 及血流动力学指标[心率(HR)、平均动脉压(MAP)、中心静脉压(CVP)]；分析2组预后指标[APACHEⅡ评分、多器官功能障碍综合征(multiple organ dysfunction syndrome，MODS)评分、机械通气时间、ICU时间及28 d病死率]及并发症发生率差异。结果 观察组治疗后气道平均压和气道平台压较对照组更低，肺顺应性、PaO2及PaO2/FiO2均较对照组高(P < 0.05)；观察组治疗后HR、MAP及CVP与对照组比较均差异无统计学意义(P>0.05)；观察组APACHEⅡ评分、MODS评分及28 d病死率均较对照组低(P < 0.05)，机械通气时间及ICU时间均较对照组短(P < 0.05)；2组并发症发生率差异无统计学意义(P>0.05)。结论 ARDS患者采用俯卧位通气有利于改善呼吸功能，对患者血流动力学影响轻微，具有临床推广价值。Abstract: Objective To investigate the effects of prone position ventilation on respiratory mechanics, oxygenation parameters and hemodynamics in patients with acute respiratory distress syndrome(ARDS).Methods Select 100 patients with ARDS admitted to our hospital from January 2018 to December 2022, and retrospectively collect clinical data. They were divided into the observation group(prone position ventilation, n=62) and the control group(supine position ventilation, n=38) according to the ventilation method. The respiratory mechanics indexes(pulmonary compliance, mean airway pressure, airway plateau pressure), oxygenation parameters(arterial partial pressure of oxygen[PaO2], arterial oxygenation index[PaO2/FiO2]) and hemodynamic indexes(heart rate[HR], mean arterial pressure[MAP], central venous pressure[CVP]) before and after treatment were compared between the two groups; The differences in prognostic indicators(APACHE Ⅱ score, multiple organ dysfunction syndrome[MODS]score, mechanical ventilation time, ICU time, and 28-day mortality) and complications between the two groups were analyzed.Results After treatment, the average airway pressure and airway plateau pressure in the observation group were lower than those in the control group, and the lung compliance, PaO2 and PaO2/FiO2 were higher than those in the control group(P < 0.05); After treatment, there was no difference in HR, MAP, and CVP between the observation group and the control group(P>0.05); The APACHEⅡ score, MODS score, and 28-day mortality rate in the observation group were lower than those in the control group(P < 0.05), and the mechanical ventilation time and ICU time were shorter than those in the control group(P < 0.05); There was no significant difference in the incidence of complications between the two groups(P>0.05).Conclusion The use of prone position ventilation in ARDS patients is beneficial for improving respiratory function, with minimal hemodynamic impact, and has clinical promotion value.
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表 1 2组呼吸力学指标比较
X±S 组别 肺顺应性/(L/cmH2O) 气道平均压/cmH2O 气道平台压/cmH2O T0 T1 T0 T1 T0 T1 观察组(n=62) 28.53±4.36 42.46±5.281) 19.91±1.81 15.06±1.361) 20.35±1.73 14.66±2.721) 对照组(n=38) 28.87±3.41 34.38±6.251) 20.27±1.69 17.44±1.351) 20.72±2.56 16.38±2.841) t 0.410 6.922 0.990 8.518 0.862 3.018 P 0.683 < 0.001 0.325 < 0.001 0.391 0.003 与同组T0比较，1)P < 0.05。 
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表 2 2组氧合参数比较
X±S 组别 PaO2/mmHga) PaO2/FiO2/mmHg T0 T1 T0 T1 观察组(n=62) 55.68±8.18 87.43±9.071) 143.98±13.41 218.44±18.031) 对照组(n=38) 57.22±9.26 80.52±8.961) 145.25±13.65 202.67±11.781) t 0.869 3.715 0.457 4.796 P 0.387 < 0.001 0.649 < 0.001 注：a)1 mmHg=0.133 kPa；与同组T0比较，1)P < 0.05。
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表 3 2组血流动力学指标比较
X±S 组别 HR/(次/min) MAP/mmHg CVP/cmH2O T0 T1 T0 T1 T0 T1 观察组(n=62) 86.67±11.21 85.33±9.75 88.57±6.87 89.09±5.99 7.29±2.13 6.88±2.35 对照组(n=38) 87.53±10.34 84.88±10.05 87.38±6.34 90.91±7.46 7.43±2.07 6.64±3.54 t 0.383 0.221 0.865 1.342 0.322 0.408 P 0.702 0.825 0.389 0.183 0.748 0.684
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表 4 2组预后比较
X±S 组别 APACHEⅡ评分/分 MODS评分/分 机械通气时间/d ICU时间/d 28 d病死率/% 观察组(n=62) 11.37±2.64 5.75±1.33 6.41±3.73 8.34±2.26 6.45(4/62) 对照组(n=38) 15.81±3.52 6.82±1.26 12.90±4.28 11.52±3.24 21.05(8/38) t/χ2 7.177 3.983 7.982 5.775 4.065 P < 0.001 < 0.001 < 0.001 < 0.001 0.029
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表 5 2组并发症发生率比较
例(%) 组别 心律失常 气道阻塞 气压伤 导管脱落 总发生率 观察组(n=62) 1(1.61) 1(1.61) 2(3.23) 3(4.84) 7(11.29) 对照组(n=38) 0(0) 2(5.26) 2(5.26) 1(2.63) 5(13.16) χ2 0.001 P 0.970
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