刘婉琳 付敏 夏兰 李林 龙专

〔摘要〕 目的 觀察改良俯卧位通气在急性呼吸窘迫综合征（acute respiratory distress syndrome， ARDS）患者中的应用效果。方法 选取2018年7月1日至2019年7月1日收治我院呼吸重症监护室接受俯卧位通气治疗的ARDS患者66例，采用随机数字表法分为对照组和观察组各33例，分别采取传统俯卧位通气与改良俯卧位通气，改良俯卧位通气在传统俯卧位通气基础上采用翻身床调整至头高脚低30°，左、右30°倾斜交替进行，每个体位维持2 h，16 h后改为仰卧位。比较两组患者血气指标、血流动力学指标、压力性损伤、胃内容物反流误吸发生率的差异。结果 俯卧位通气16 h后观察组与对照组血气pH值、二氧化碳分压、氧分压、氧合指数、心率、平均动脉压、中心静脉压对比，均无统计学差异（P>0.05）;对照组36.36%（12/33）患者发生压力性损伤，其中Ⅰ期9例，Ⅱ期3例;观察组9.09%（3/33）发生了Ⅰ期压力性损伤， 2组患者压力性损伤的发生率和分期比较，差异均有统计学意义（P<0.05）。对照组24.24%（8/33）、观察组6.06%（2/33）患者发生了胃内容物反流误吸，差异具有统计学意义（P<0.05）。结论 改良俯卧位通气对ARDS患者血气及血流动力学指标无不良影响，能够降低压力性损伤及胃内容物反流误吸的发生。

〔关键词〕 改良俯卧位通气;急性呼吸窘迫综合征;压力性损伤;误吸;血气分析;血流动力学

〔中图分类号〕R2;R563       〔文献标志码〕B       〔文章编号〕doi：10.3969/j.issn.1674-070X.2021.07.026

〔Abstract〕 Objective To observe the effect of modified prone position ventilation in the treatment of patients with acute respiratory distress syndrome （ARDS）. Methods 66 patients patients with ARDS who required prone position ventilation in the respiratory intensive care unit （RICU） from July 1 2018 to July 1 2019 were included in our study. By random number table method， the patients were randomly divided into the control group （n=33） and the intervention group （n=33）. Traditional prone ventilation and improved prone ventilation were adopted， respectively. In the improved prone ventilation， on the basis of the traditional prone ventilation， the head was adjusted to 30° low by turning over the bed， and the left and right 30° inclined alternatively. Each position was maintained for 2 hours， and the latter was changed to supine position 16 hours later. Blood gas index， hemodynamics index， incidence of pressure injury and rate of gastric contents regurgitation and aspiration were compared. Results There was no significant difference in blood gas pH value， PaCO2 value， PaO2， PaO2/FiO2， heart rate， mean arterial pressure， central venous pressure between the observation group and the control group （P>0.05） after 16 hours of prone ventilation. 36.36% （12/33） of the patients developed pressure injuries were found in the control group， including 9 patients in stage Ⅰand 3 patients in stageⅡ. However， 9.09% （3/33） patients were found in intervention group in stage Ⅰpressure injuries. There were statistical differences in the incidence of pressure injury and stages between the two groups （P<0.05）. The incidence of gastric contents regurgitation and aspiration was 24.24% （8/33） in the control group while 6.06% （2/33） in intervention group， and the difference was statistically significant （P<0.05）. Conclusion The application of modified prone position ventilation has no effect on blood gas indexes， hemodynamic indexes， but can reduce the incidence of pressure injury and gastric contents regurgitation and aspiration.

〔Keywords〕 modified prone position ventilation; acute respiratory distress syndrome; pressure injury; aspiration; blood gas analysis; hemodynamics

急性呼吸窘迫综合征（acute respiratory distress syndrome， ARDS）是一种在肺内及肺外因素的作用下发生的以顽固性低氧血症为主要特征的临床综合征，在全球范围内每年约300万例患者罹患ARDS，占重症监护病房（intensive care unit， ICU）患者的10%[1]。目前已经证明有效的唯一疗法是基于潜在生理学原理的肺保护性通气策略，包括小潮气量、呼气末气道内正压、俯卧位通气以及早期肌松剂的使用[2-4]。而俯卧位通气因为操作简单、一般不需要额外器械辅助，且不增加患者医疗负担而在临床上广泛使用。而在……