不同角度俯卧位通气在急性呼吸窘迫综合征患者中的应用效果

doi:10.3760/cma.j.issn.1007-1245.2024.12.027

摘要/Abstract

摘要：

目的　评估不同角度俯卧位通气在急性呼吸窘迫综合征（ARDS）患者中的应用效果。方法　本研究为一项前瞻性、随机、对照临床试验，纳入2021年7月至2023年6月广东省第二中医院重症医学科（ICU）收治的ARDS患者共96例，随机分为A组（0°俯卧位通气）、B组（30°俯卧位通气）、C组（45°俯卧位通气），每组32例。A组男19例，女13例；年龄（50.25±11.31）岁；体重指数（BMI）（23.42±3.16）kg/m²。B组男17例，女15例；年龄（51.93±12.48）岁；BMI（22.72±4.15）kg/m²。C组男20例，女12例；年龄（52.39±12.82）岁；BMI（24.76±4.31）kg/m²。观察时间为5 d。A组患者每天持续0°俯卧位通气16 h，每2 h将其托起一次防止压力性损伤。B组：维持0°俯卧位2 h后，使用30°翻身垫将患者身体向左倾斜30°，维持2 h；然后向右倾斜30°，同样维持2 h；最后恢复至0°俯卧位，如此循环，直至完成16 h俯卧位通气。C组：维持0°俯卧位2 h后，使用45°翻身垫将患者身体向左倾斜45°，维持2 h；然后向右倾斜45°，同样维持2 h；最后恢复至0°俯卧位，如此循环，直至完成16 h俯卧位通气。比较3组氧合指标［氧合指数（PaO₂/FiO₂）、动脉血氧饱和度（SaO₂）、动脉血氧分压（PaO₂）、动脉血二氧化碳分压（PaCO₂）］、血流动力学指标［心率（HR）、平均动脉压（MAP）、中心静脉压（CVP）］、Murray肺损伤评分（MLIS）、急性生理学及慢性健康状况评价Ⅱ（APACHEⅡ）评分、多器官功能障碍综合征（MODS）评分的变化，观察压力性损伤发生率。采用单因素方差分析、LSD法、配对t检验、χ²检验。结果　俯卧位通气5 d后，3组PaO₂/FiO₂、SaO₂、PaO₂、PaCO₂均较通气前改善，且A组、B组改善幅度均优于C组（均P<0.05）；俯卧位通气前和通气5 d后，3组HR、MAP、CVP差异均无统计学意义（均P>0.05）；俯卧位通气5 d后，3组MLIS、APACHEⅡ、MODS评分均较通气前降低，且A组、B组均低于C组［（1.72±0.37）分比（1.54±0.16）分比（1.89±0.26）分、（11.02±2.69）分比（11.01±2.01）分比（12.87±2.06）分、（5.64±0.37）分比（5.34±0.67）分比（6.19±0.43）分］（均P<0.05）；B组和C组压力性损伤发生率低于A组［15.63%（5/32）比18.75%（6/32）比40.63%（13/32）］（P<0.05）。结论　不同角度俯卧位通气均可以改善ARDS患者氧合和减轻病情，其中30°俯卧位通气改善最明显，并且可以降低压力性损伤发生率。

关键词:

急性呼吸窘迫综合征, 俯卧位通气, 不同角度, 氧合指数, 血流动力学, 压力性损伤

Abstract:

Objective　To evaluate the effects of prone position ventilation at different angles on patients with acute respiratory distress syndrome (ARDS). Methods　This prospective, randomized, controlled clinical trial included 96 patients with ARDS admitted to the Intensive Care Unit (ICU) of Guangdong Second Hospital of Traditional Chinese Medicine from July 2021 to June 2023. The patients were randomly divided into group A (0° prone position ventilation), group B (30° prone position ventilation), and group C (45° prone position ventilation), with 32 cases in each group. There were 19 males and 13 females in group A, aged (50.25±11.31) years, with a body mass index (BMI) of (23.42±3.16) kg/m². There were 17 males and 15 females in group B, aged (51.93±12.48) years, with a BMI of (22.72±4.15) kg/m². There were 20 males and 12 females in group C, aged (52.39±12.82) years, with a BMI of (24.76±4.31) kg/m². The observation time was 5 days. The patients in group A were continuously ventilated in the prone position at 0° for 16 h every day and lifted up every 2 h to prevent stress injury. In group B, after maintaining 0° prone position for 2 h, the patients' body was tilted to the left for 30° with the 30° turning pad for 2 h, then it was tilted to the right for 30° for 2 h, finally returned to 0° prone position. This was repeated until 16 h of prone ventilation was completed. In group C, after maintaining 0° prone position for 2 h, the patients' body was tilted to the left for 45° with the 45° turning pad for 2 h, then it was tilted to the right for 45° for 2 h, finally returned to 0° prone position. This was repeated until 16 h of prone ventilation was completed. The changes in oxygenation indicators [oxygenation index (PaO₂/FiO₂), arterial oxygen saturation (SaO₂), arterial partial pressure of oxygen (PaO₂), and arterial partial pressure of carbon dioxide (PaCO₂)], hemodynamic indexes [heart rate (HR), mean arterial pressure (MAP), and central venous pressure (CVP)], Murray Lung Injury Score (MLIS), Acute Physiology and Chronic Health Evaluation Ⅱ (APACHEⅡ) score, and multiple organ dysfunction syndrome (MODS) score were compared among the three groups. The incidence of pressure injury was also observed. One-way analysis of variance, LSD method, paired t test, and χ² test were used. Results　After 5 days of prone position ventilation, the PaO₂/FiO₂, SaO₂, PaO₂, and PaCO₂ in the three groups were improved compared with those before ventilation, and the improvement ranges of group A and group B were better than those of group C (all P<0.05). There were no statistically significant differences in the HR, MAP, or CVP among the three groups before and after 5 days of prone position ventilation (all P>0.05). After 5 days of prone position ventilation, the MLIS, APACHEⅡ, and MODS scores of the three groups were lower than those before ventilation; those of group A and group B were lower than those of group C [(1.72±0.37) points vs. (1.54±0.16) points vs. (1.89±0.26) points, (11.02±2.69) points vs. (11.01±2.01) points vs. (12.87±2.06) points, (5.64±0.37) points vs. (5.34±0.67) points vs. (6.19±0.43) points] (all P<0.05). The incidences of pressure injury in group B and group C were lower than that in group A [15.63% (5/32) vs. 18.75% (6/32) vs. 40.63% (13/32)] (P<0.05). Conclusions　Prone position ventilation at different angles can improve the oxygenation and alleviate the condition in patients with ARDS. Among the studied angles, 30° prone position ventilation shows the most significant improvement and reduces the incidence of pressure injury.

Key words:

Acute respiratory distress syndrome, Prone position ventilation, Different angles, Oxygenation index, Hemodynamics, Pressure injury

梁艳东何伟枫刘秋江黎燕红庾佳燕.

不同角度俯卧位通气在急性呼吸窘迫综合征患者中的应用效果 [J]. 国际医药卫生导报, 2024, 30(12): 2063-2067.

Liang Yandong, He Weifeng, Liu Qiujiang, Li Yanhong, Yu Jiayan.

Effects of prone position ventilation at different angles on patients with acute respiratory distress syndrome [J]. International Medicine and Health Guidance News, 2024, 30(12): 2063-2067.

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