【摘要】 探讨急性呼吸窘迫综合征患者俯卧位通气最佳呼气末正压水平选择及对肺复张效果的影响。方法 将60例急性呼吸窘迫综合征患者采用随机数字表法分为A、B、C三组,均给予机械通气治疗,并行俯卧位通气联合呼气末正压促使肺复张,三组呼气末正压分别为10 cmH₂O、15 cmH₂O、20 cmH₂O,维持20 min。测定三组动脉二氧化碳血氧分压、氧合指数、平均动脉压、心率,并行CT检查,评估肺复张情况。比较三组28 d死亡率及并发症发生率。结果 肺复张20 min三组动脉二氧化碳血氧分压显著降低,氧合指数显著上升,肺通气情况明显改善（P<0.05）;复张20 min三组动脉二氧化碳血氧分压比较差异无统计学意义（P>0.05）,B组、C组复张20 min氧合指数、肺通气改善情况优于A组（P<0. 05）,B组肺通气改善优于A组（P<0. 05）。A组、B组复张20 min平均动脉压、心率无变化（P>0. 05）,C组复张20 min平均动脉压显著下降（P<0. 05）,且显著低于A组、B组（P<0. 05）。三组患者并发症发生率及28 d病死率比较差异无统计学意义（P>0. 05）。结论 俯卧位通气联合呼气末正压15 cmH₂O可显著改善急性呼吸窘迫综合征患者的氧合状况,且对血流动力学影响较小。更多还原

【Abstract】 Objective To investigate the selection of the best positive end-expiratory pressure level of prone position ventilation and effect of recruitment maneuvers in patients with ARDS. Methods 60 cases of patients with acute respiratory distress syndrome were randomly divided into groups A, B,C,they were all given mechanical ventilation, and prone position ventilation combined with positive end-expiratory pressure to promote lung recruitment. The three groups were combined with 10 cmH₂O, 15 cmH₂O and20 cmH20 respectively for 20 min. The arterial carbon dioxide partial pressure, oxygenation index, mean arterial pressure, heart rate of the three groups were detected. CT examination was performed to assess lung recruitment. The 28 d mortality and rate of complications of the 3 groups were compared. Results After 20 min of recruitment maneuver, PaCO₂ decreased in three groups while PaO₂/FiO₂ increased, and pulmonary ventilation was significantly improved. After 20 min of recruitment maneuver, there were no significant differences in PaCO₂ among the three groups（P> 0. 05）, PaO₂/FiO₂ and improvement of pulmonary ventilation in group B and group C were better than those in group A（P<0. 05）, the improvement of pulmonary ventilation in group B was better than that in group A（P<0. 05）. After 20 min of recruitment maneuver, there were no changes of MAP and HR in group A and group B（P> 0. 05） while MAP decreased in group C（P<0. 05）; MAP of group C was lower than that of group A and group B（P<0. 05）. There was no significant difference in the incidence of complications and 28 d mortality among the three groups（P>0. 05）. Conclusion The application of PEEP15 cmH₂O in prone position ventilation for patients with ARDS can effectively improve oxygenation status and has less effect on hemodynamics.更多还原