俯卧位通气对神经重症术后患者呼吸的影响

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摘要目的：探讨俯卧位通气（PPV）治疗对神经重症术后患者呼吸及预后的影响。方法：筛选出神经重症术后第7天运动评分4～5分，Murray肺损伤评分（LIS）＞1分的32例患者。试验组（15例）PPV治疗2次/d，2 h/次；对照组（17例）常规半卧位。3 d后若LIS下降≥0.5分，继续原方案；若LIS下降＜0.5分，10～14 d行气管切开术。继续原方案者若14 d内自主呼吸试验失败者行气管切开术。结果：试验组治疗后较对照组氧合指数升高，LIS下降，气管插管拔除成功率增加，普通病房抗菌药物使用率降低（均P＜0.05）；机械通气时间、ICU住院时间、总住院时间、3个月后GOS差异均无统计学意义（P＞0.05）。翻转为俯卧位后心率、平均动脉压无显著改变（P＞0.05）。结论：PPV治疗可改善神经重症术后患者的肺衰竭症状，降低因其引起的气管切开，减少后期医院获得性肺炎的发生，可安全应用于术后7 d患者，但对疾病转归无明显改善。

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	陈杰
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	郝钰

关键词 ：俯卧位通气, 神经外科术后, 术后重症监护室, 肺损伤评分, 气管插管拔除

Abstract：Objective: To investigate the effects of prone position ventilation on lung function and prognosis in neurointensive care patients. Methods: A total number of 32 neurointensive care patients with Motor Score (4-5) and Lung Injury Scores (LIS)>1 on the 7th day after surgery were enrolled in this study. They were randomly divided into two groups, the research group (n=15) (daily prone position 2 times/day, 2 hours/time) and the control group (n=17), treated with supine bed elevation of 30°-45°. We assessed LIS again on the 10th day and continued to observe if LIS fell by≥0.5. Otherwise, tracheotomy was performed on the 10th-14th day. Tracheotomy was also performed on those patients who had remained to be observed if they failed to pass spontaneous breathing trial within 14 days. Results: Compared with the control group, the oxygenation index and extubation success rate in the research group increased after treatment and meanwhile LIS and use of antibiotics in general ward dropped (P<0.05). There was no difference in mechanical ventilation time, the length of ICU stay, total hospital stay, and Glasgow Outcome Scale after 3 months. No significant changes took place in heart rate and mean arterial pressure after turning to prone position (P>0.05). Conclusion: Prone position ventilation improves lung function in postoperative neurological intensive patients and reduces the rate of tracheotomy and hospital-acquired pneumonia in general ward. It can be safely applied to postoperative patients after one week. However, there was no obvious improvement in the prognosis of the disease.

Key words： prone position ventilation neurosurgical procedures postoperative care lung injury score airway extubations

收稿日期: 2017-07-15

基金资助:温州市医药卫生科学研究计划项目（2017B17）。

通讯作者: 金胜威，主任医师，教授，Email：jinshengwei69@ 163.com。

作者简介: 陈杰（1984-），男，浙江瑞安人，主治医师，硕士。

链接本文:

https://xb.wmu.edu.cn/CN/ 或 https://xb.wmu.edu.cn/CN/Y2018/V48/I6/450

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