常规姿势重新定位对机械呼吸患者肺透气和 perfusion 的分布的影响
María Dolores Rodríguez Huerta1, Juan Antonio Sánchez Giralt1, Ana Díez-Fernández2
1Department of Intensive Care Medicine, Hospital Universitario de La Princesa, Madrid, Spain.
Intensive & critical care nursing
|January 26, 2025
概括
机械通风患者的常规姿势重新定位可以改善肺部机械和气体交换. 这种方法耐受性很好,可以增加区域性肺体积,而不会减少依赖性肺体积.
科学领域:
- 关键护理医学 关键护理医学
- 呼吸系统生理学 呼吸系统生理学
- 肺动脉工程 肺动脉工程
背景情况:
- 机械通风的重症患者往往会出现呼吸功能受损和肺部通风不均.
- 常规的姿势重新定位是一种常见的干预措施,但它对区域肺机械和气体交换的精确影响需要详细分析.
研究的目的:
- 分析例行姿势重新定位对呼吸功能,肺体积以及机械通风患者呼吸和 perfusion 的区域分布的影响.
- 评估身体位置的连续变化的耐受性和生理影响.
主要方法:
- 一项前性描述性生理学研究,涉及32名机械呼吸患者.
- 使用电阻断层扫描 (EIT) 评估气体交换,肺机械和区域通风/ perfusion 在五个身体位置 (后背,侧面).
- 基线卧卧位置与随后的卧卧和横侧位置进行比较,以评估变化.
主要成果:
- 姿势变化被很好地容忍. 通过比较起始和最后的仰卧姿势,呼吸系统的符合性增加了7%,PaO2/FiO2比率增加了16%,死亡空间减少了5%.
- 侧面化并没有显著改变血液动力学或PaO2/FiO2.2. 在非依赖性和依赖性肺部区域,终端呼气肺阻抗增加.
- 区域通风向依赖肺部转移,而依赖肺部区域的区域 perfusion 减少,表明分布发生了变化.
结论:
- 常规的姿势重新定位对于机械通风ICU患者来说是安全和有益的,改善了肺机械和气体交换.
- 姿势变化增加了区域末呼吸肺体积,并且可以使用像EIT这样的监测工具来个性化.
- 侧面化不会导致依赖肺部的肺体积减少,支持其用于通风分配.
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