摘要
【目的】探讨重症肺炎患者肺复张治疗中不同体位对血流动力学的影响。【方法】重症肺炎患者90例,根据肺复张治疗中选取的体位不同分成仰卧位组(A组)、俯卧位组(B组),各45例。分别在肺复张前、肺复张后5 min和1 h观察患者氧代谢指标动脉氧分压(PaO2)、混合静脉血氧分压(PvO2).中心静脉血氧饱和度(ScvO2),氧供(DO2)、氧摄取率(ERO2)的变化。分别在肺复张前、肺复张即刻、肺复张后1 h记录两组血流动力学指标中心静脉压(CVP)、心脏指数(CI)、全心射血分数(GEF)、外周血管阻力指数(SVRI)、每搏量变异(SVV)、胸内血容量指数(ITBVI)的变化,并观察两组患者并发症发生率。【结果】两组肺复张后5 min、1h的PaO2、PvO2、ScvO2、DO2均高于肺复张前(P<0.05),且B组显著高于A组(P<0.05)。两组肺复张后5 min、1h的ERO2低于肺复张前(P<0.05),但组间比较无显著差异(P>0.05)。两组肺复张即刻的CVP、CI、GEF显著低于肺复张前(P<0.05),SVV显著高于肺复张前(P<0.05),两组间上述指标相比较差异均无显著性(P>0.05).两组皮下气肿、气胸、气压伤发生率比较差异无统计学意义(P>0.05)。【结论】重症肺炎患者选取仰卧位、俯卧位行肺复张,均对血流动力学影响较小,并发症少,其中选取俯卧位能进一步改善患者氧代谢,效果更显著。
【Objective】To investigate the effects of different positions on hemodynamics in patients with severe pneumoni-as undergoing lung recruitment therapy.【Methods】Ninety patients with severe pneumonia were divided into supine position group(group A)and prone position group(group B)according to the body position selected in the treatment of lung recruitment.The changes of oxygen metabolism were observed before,5 minutes and 1 hour after pulmonary reopening,including arterial partial pressure of oxygen(PaO2), mixed venous partial pressure of oxygen(PvO2)>central venous oxygen saturation(ScvO2),oxygen supply(DO2)and oxygen uptake rate(ERO2)-Hemodynamic changes were recorded before,immediately after and I hour after pulmonary recruitment,including central venous pressure(CVP),cardiac index(CI),global ejection fraction(GEF),peripheral vascular resistance index(SVRI),stroke volume variation(SW),intrathoracic blood volume in-dex(ITBVI),The incidence of complications in the two groups was also observed.【Results】The levels of PAO2,PvO2,Scv02 and DO2 of the two groups before lung recruitment were higher than those at 5min and Ih after recruitment(P<0.05).Those parameters in group B were significantly higher than those in the group A(P<0.05).The level of ERO2 at 5 minutes and I hour after lung recruitment was lower than that before lung recruitment(P<0.05),however,there was no statistically significant difference in between(P>0.05).The CVP>CI and GEF levels of the two groups immediately after recruitment were significantly lower than those before lung recruitment(P<0.05),and the SW was significantly higher than that before lung recruitment(P<0.05).There were no significant differences in CVP,Cl,GEF,SVRI,SW and ITBVI between the two groups(P>0.05).There was no significant difference in the incidence of subcutaneous emphysema,pneumothorax and barotrauma between the two groups as well(P>0.05).【Conclusion】Choosing supine position or prone position for lung recruitment in patients with severe pneumonia has less influence on hemodynamics and fewer complications.Prone position can further improve oxygen metabolism,and the effect is more remarkable.
作者
严锡祥
郑爱东
张振恩
潘国翠
崔永华
YAN Xi-Xiang;ZHENG Ai-dong;ZHANG Zhen-en(Jianhu County Hospital Affiliated to Nantong University,Yancheng Jiangsu 224700)
出处
《医学临床研究》
CAS
2020年第11期1647-1649,1653,共4页
Journal of Clinical Research
基金
江苏省第五期“333工程”培养资金资助项目(BRA2017219)。
关键词
肺炎
血流动力学
中心静脉压
血气监测
经皮
Pneumonia
Hemodynamics
Central Venous Pressure
Blood Gas Monitoring,Transcutaneous
