俯卧位通气对神经重症术后患者呼吸的影响

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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

Received: 15 July 2017

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	Articles by authors
	CHEN Jie
	JIN Shengwei
	JIANG Xiaofen
	YE Bingbing
	CHEN Rui
	HAO Yu.

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https://xb.wmu.edu.cn/EN/ OR https://xb.wmu.edu.cn/EN/Y2018/V48/I6/450

[1] PEETERS W, VAN DEN BRANDE R, POLINDER S, et al. Epidemiology of traumatic brain injury in Europe[J]. Acta Neurochir, 2015, 157(10): 1683-1696.
[2] 官念, 吴碧华, 刘黎明, 等. 脑出血病因及相关机制的研究进展[J]. 中华老年心脑血管病杂志, 2016, 18(6): 670-672.
[3] ZYGUN D A, KORTBEEK J B, FICK G H, et al. Non-neurologic organ dysfunction in severe traumatic brain injury[J].Crit Care Med, 2005, 33(3): 654-660.
[4] 贾洛·洛夫特斯. 颅脑创伤和脑科危重症治疗学[M]. 高亮,译. 上海: 上海科学技术出版社, 2012: 291.
[5] 中华医学会神经外科学分会, 中国医师协会重症医学医师分会, 中国病理生理学会危重病医学专业委员会. 神经外科医院感染抗菌药物应用专家共识(2012)[J]. 中华医学杂志, 2013, 93(5): 322-329.
[6] FAN E, DEL SORBO L, GOLIGHER E C, et al. An Official American Thoracic Society/European Society of Intensive Care Medicine/Society of Critical Care Medicine Clinical Practice Guideline: Mechanical ventilation in adult patients with acute respiratory distress syndrome[J]. Am J Respir Crit Care Med, 2017, 195(11): 1253-1263.
[7] 罗红, 张晗.俯卧位通气的细节和实施[J]. 中华结核和呼吸杂志, 2016, 39(9): 666-668.
[8] NEKLUDOV M, BELLANDER B M, MURE M, et al. Oxygenation and cerebral perfusion pressure improved in the prone position[J]. Acta Anaesthesiol Scand, 2006, 50(8): 932-936.
[9] ROTH C, FERBERT A, DEINSBERGER W, et al. Does prone positioning increase intracranial pressure? A retrospectiveanalysis of patients with acute brain injury and acute respiratory failure[J]. Neurocrit Care, 2014, 21(2): 186-191.
[10] THELANDERSSON A, CIDER A, NELLGARD B. Prone position in mechanically ventilated patients with reduced intracranial compliance[J]. Acta Anaesthesiol Scand, 2006, 50(8): 937-941.
[11] 邱海波, 于凯江. ICU主治医师手册[M]. 2版. 南京: 江苏科学技术出版社, 2013: 179.
[12] KANGELARIS K N, CALFEE C S, MAY A K, et al. Is there still a role for the lung injury score in the era of the Berlin definition ARDS?[J]. Ann Intensive Care, 2014, 4(1): 4.
[13] 中华医学会神经外科学分会. 中国神经外科重症患者气道管理专家共识(2016)[J]. 中华医学杂志, 2016, 96(21): 1639-1642.
[14] HEALEY C, OSLER T M, ROGERS F B, et al. Improving the Glasgow Coma Scale Score: motor score aloneisa better predictor[J]. J Trauma, 2003, 54(4): 671-680.
[15] 吴在德, 吴肇汉. 外科学[M]. 7版. 北京: 人民卫生出版社, 2008: 246.