目的 探討側(cè)臥位通氣對ARDS 患者肺容積和氧合的影響。方法 對14 例ARDS 機械通氣患者均先后行仰臥位、側(cè)臥位、仰臥位通氣各1 h。各體位通氣結(jié)束時測定患者呼氣末容積( EELV) , 并觀察動脈血氣、肺機械力學(xué)和血流動力學(xué)變化。結(jié)果 EELV 在側(cè)臥位后由( 1109 ±321) mL增加到( 1376 ±381) mL( P lt;0. 05) , 恢復(fù)仰臥位后下降至( 1143 ±376) mL( P lt;0. 05) , 而恢復(fù)仰臥位后與初始仰臥位相比無顯著差異( P gt; 0. 05) 。PaO2 /FiO2 側(cè)臥位后由( 154. 3 ±35. 0) mmHg增加到( 189.9 ±60. 1) mmHg ( P lt; 0.05) , 恢復(fù)仰臥位后繼續(xù)增加至( 209. 2 ±75. 4) mmHg( P lt;0. 05) , 并較初始仰臥位明顯增加( P lt;0. 01) 。體位改變后PaCO2 、肺機械力學(xué)、血流動力學(xué)均無明顯變化。結(jié)論 ARDS 機械通氣患者采用側(cè)臥位通氣后可增加EELV 并改善氧合。
引用本文： 于湘友,潘鵬飛,拜合提尼沙吐爾地. 側(cè)臥位通氣對急性呼吸窘迫綜合征患者肺容積和氧合的影響. 中國呼吸與危重監(jiān)護(hù)雜志, 2009, 09(6): 555-557. doi: 復(fù)制
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| 4. | 中華醫(yī)學(xué)會呼吸病學(xué)分會. 急性肺損傷/急性呼吸窘迫綜合征的診斷標(biāo)準(zhǔn)( 草案) . 中華結(jié)核和呼吸雜志, 2000, 23: 203. |
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| 8. | Staudinger T, Kofler J, 秦龍, 等. 成人呼吸窘迫綜合征病人俯臥位和持續(xù)變換體位通氣的比較: 一項初步研究. 世界醫(yī)學(xué)雜志,2002, 6: 9-13. |
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| 10. | Oleg rd C, S ndergaard S, Houltz E, et al. Estimation of functional residual capacity at the bedside using standard monitoring equipment: a modified nitrogen washout/ washin technique requiring a small change of the inspired oxygen fraction. Anesth Analg, 2005 ,101: 206-212. |
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- 1. 吳威士, 羅敏, 楊翠華. 急性肺損傷/急性呼吸窘迫綜合征患者側(cè)臥位通氣與俯臥位通氣的對比觀察. 中華結(jié)核和呼吸雜志,2004, 27: 589-592.
- 2. Tongyoo S, Vilaichone W, Ratanarat R, et al. The effect of lateral position on oxygenation in ARDS patients: a pilot study. J Med Assoc Thai, 2006, 89( Suppl 5) : S55-S61.
- 3. 張麗娜, 艾宇航. 急性呼吸窘迫綜合征患者側(cè)臥位通氣與俯臥位通氣的臨床療效觀察. 中國急救醫(yī)學(xué), 2006, 26: 908-910.
- 4. 中華醫(yī)學(xué)會呼吸病學(xué)分會. 急性肺損傷/急性呼吸窘迫綜合征的診斷標(biāo)準(zhǔn)( 草案) . 中華結(jié)核和呼吸雜志, 2000, 23: 203.
- 5. 中華醫(yī)學(xué)會重癥醫(yī)學(xué)分會. 急性肺損傷/急性呼吸窘迫綜合征診斷和治療指南( 2006) . 中國危重病急救醫(yī)學(xué), 2006,18:706-710.
- 6. Remolina C, Khan AU, Santiago TV, et al. Positional hypoxemia in unilateral lung disease. N Engl JMed, 1981, 304: 523-525.
- 7. Flaatten H, Aardal S, Hevr y O. Improved oxygenation using the prone position in patients with ARDS. Acta Anaesthesiol Scand,1998, 42: 329-334.
- 8. Staudinger T, Kofler J, 秦龍, 等. 成人呼吸窘迫綜合征病人俯臥位和持續(xù)變換體位通氣的比較: 一項初步研究. 世界醫(yī)學(xué)雜志,2002, 6: 9-13.
- 9. Klingstedt C, Hedenstiema G, Baehrendtz S, et al. Ventilationperfusion relationships and atelectasis formation in the supine and lateral positions during conventional mechanical and differential ventilation. Acta Anaesthesiol Scand, 1990 , 34: 421 -429.
- 10. Oleg rd C, S ndergaard S, Houltz E, et al. Estimation of functional residual capacity at the bedside using standard monitoring equipment: a modified nitrogen washout/ washin technique requiring a small change of the inspired oxygen fraction. Anesth Analg, 2005 ,101: 206-212.
- 11. Heinze H, Sedemund-Adib B, Heringlake M, et al. Functional residual capacity changes after different endotracheal suctioning methods. Anesth Analg, 2008, 107: 941-944.