Effects of Prone Ventilation Combined with Recruitment Maneuver on Oxygenation Function and Recruitment Maneuver Volume in Patients with Severe ARDS/CAO Xuefeng，DAN Chuanjun.//Medical Innovation of China，2025，22（18）：005-010

[Abstract]Objective： To explore the efects of prone ventilation combined with recruitment maneuver （RM） on oxygenation function and RM volume in patients with severe acute respiratory distresssyndrome （ARDS）. Method： A total of8O patients with severe ARDS diagnosedand treated in Afiliated HospitalofJiujiang University from March 2021 to March 2O24 were divided into two groupsaccording to random number table method， with 40 cases in each group.Both groups received conventional mechanical ventilation treatment.The control group was treated with RM，and the treatment group was treated with prone ventilation combined with RM.The RM volume， oxygenation function，hemodynamics，breathing mechanics indicatorsand prognostic related indicators were compared between the two groups.Result：At T1，there was no statisticallysignificant diffrence inRM volume between the two groups （ P gt;0.05）. At T₂ and Γ₃ ，the RM volume of both groups showed an increasing trend，and thoseofthetreatment group were higherthan thoseofthecontrol group，thedifferences werestatisticallysignificant （ P lt;0.05）. At To， I₁ and T2，there were no statistically significant diferences in arterial partial pressure of oxygen （PaO ¹2 ）/fractionof inspired oxygen （FiO ^-2， and Pa0₂ between the two groups （ Pgt; 0.05）. At T₁ 1 ^-2 and T₃ ，PaO2/FiO ² and Pa0₂ in both groups showed an increasing trend， at T3， PaO₂/FiO₂ and Pa0₂ in the treatment group were higher than those in the control group，the differences were statistically significant （ P lt;0.05）. At T₀ ，T， Γ₂ and T3，there were no statisticallysignificant differences in heartrate （HR），centralvenous pressure （CVP）and meanarterial pressure （MAP） between the two groups （ Pgt; 0.05）. At T₀ Γ₁ and T₂ ，there were no statistically significant differences in peak airway pressure （Ppeak）， static lung compliance （Cst） and plateau pressure （Pplat） between the two groups （ Pgt;0.05 ）. At T3， the Ppeak inthe treatment group was lower than that inthe control group，and the Cst was higher than that in the control group，the differences were statistically significant （ P lt;0.05）. There was no statistically significant difference in Pplat between the two groups at' Γ₃ （ P gt;0.05）. The 28-day mortality rate in the treatment group was lower than that in the control group，and the mechanical ventilation time wasshorter than thatin thecontrol group，the differences were statistically significant （ P lt;0.05）. There was no significant difference in the incidence of adverse events between the two groups （ P gt;0.05）.Conclusion：Prone ventilation combined with RM can significantly improve the oxygenationfunctionof patients with severe ARDS，increaseRMvolume，stabilize hemodynamics，enhance breathing mechanics，and improve prognosis.

[Key Words]Prone ventilationRecruitment maneuverSevere acute respiratory distress syndrome Oxygenation function Recruitment maneuver volume

First-author's address： Department of Emergency， Afiliated Hospital of Jiujiang University， Jiujiang 332000， China

doi：10.3969/j.issn.1674-4985.2025.18.002

急性呼吸窘迫综合征（ARDS）是一种急性缺氧性呼吸功能障碍，患病后因肺毛细血管内皮细胞损伤，患者多伴有氧合功能障碍，严重威胁患者生命[]。目前呼吸支持是ARDS除积极治疗原发病外的主要治疗手段，故积极探索与改进呼吸支持治疗模式是当前危急重症领域的研究热点。肺复张（RM）策略因能够促进塌陷肺泡开放、改善氧合而被临床广泛应用于重症ARDS患者中，但完全“安全”的肺保护通气并不存在[2。有研究表明，RM后的肺组织顺应性较ARDS正常通气时的肺组织低，导致RM后仍有部分气体分布于正常通气肺组织中，使正常通气肺泡出现过度膨胀现象，且受ARDS不均一性肺组织的影响，不同区域间肺泡闭合压力、顺应性各有差异，导致重力依赖性肺泡复张无效[3]。由此可见，RM不适当可能会导致肺组织不均一性加重，不利于肺保护。俯卧位通气能够借助对重力依赖区的改变，扩张萎陷肺泡，重新分布肺部气体，有学者报道该方式可作为改善顽固性低氧血症的可靠方法[4]。近年随着临床对俯卧位通气机制研究的深入，其对ARDS患者氧合状况的影响也成为重点研究方向之一[5。此外，有文献报道动脉氧合指数的变化不仅与自身肺泡复张程度相关，还与RM容积呈正相关性[。但临床对于俯卧位通气是否能改变患者的RM容积仍有争议。对此，本研究通过对重症ARDS患者施以俯卧位通气联合RM，进一步探讨其对患者氧合功能及RM容积的影响，内容如下。

1资料与方法

1.1一般资料