| Citation: |
LIANG Huan, WANG Fudong, JIANG Lijun, LIU Feng, LIU Shunying, WU Mingfu. Clinical application of ventilation in prone position in treatment of neonatal acute respiratory distress syndrome[J]. Journal of Clinical Medicine in Practice, 2022, 26(14): 114-118. DOI: 10.7619/jcmp.20220211
|
To observe application effect of ventilation in prone position in treatment of neonatal acute respiratory distress syndrome (NARDS).
A total of 46 neonates with NARDS were retrospectively selected as study objects, among whom 20 cases with ventilation in prone position(mainly using prone position, and alternatively using lateral position) were included in prone position group, while 26 cases ventilated in conventional supine position were selected as supine position group. Arterial partial pressure of oxygen[pa(O2)] to inhaled oxygen fraction (FiO2) ratio (P/F) and oxygenation index of two groups of neonates at beginning of mechanical ventilation, and 4, 24, 48 and 72 h after mechanical ventilation were compared. The number of using pulmonary surfactant (PS) during treatment, mechanical ventilation time, total oxygen use time and length of hospital stay were observed, the incidence rates of related complications and the mortality during treatment were compared.
The pa(O2) and P/F values of the neonates in the prone position group were higher than those of the supine position group, and the OI value was lower than that of the supine position group at 4, 24, 48 and 72 h after mechanical ventilation (P < 0.05); arterial partial pressure of carbon dioxide[pa(CO2)] after 72 h of mechanical ventilation was lower than that of the supine position group(P < 0.05). The total oxygen consumption time in the prone position group was shorter than that in the supine position group[(12.53±3.48) d versus (15.60±4.46) d, P < 0.05]. There were no significant differences in number of pulmonary surfactant usage, mechanical ventilation time and hospital stay (P>0.05). The incidence rates of neonatal persistent pulmonary hypertension, mortality, and complications between the two groups showed no significant differences(P>0.05).
Prone position mechanical ventilation can effectively improve the oxygenation and respiratory function of neonates with NARDS, shorten the time of oxygen use, and does not increase the occurrence of related complications.
| [1] |
唐烁, 包蕾. 新生儿急性呼吸窘迫综合征临床特征与预后相关因素分析[J]. 第三军医大学学报, 2019, 41(9): 898-902. https://www.cnki.com.cn/Article/CJFDTOTAL-DSDX201909014.htm
|
| [2] |
MARRARO G A, CHEN C, PIGA M A, 等. 儿童急性呼吸窘迫综合征的治疗进展[J]. 中国当代儿科杂志, 2014, 16(5): 437-447. https://www.cnki.com.cn/Article/CJFDTOTAL-DDKZ201405001.htm
|
| [3] |
DE LUCA D, VAN KAAM A H, TINGAY D G, et al. The Montreux definition of neonatal ARDS: biological and clinical background behind the description of a new entity[J]. Lancet Respir Med, 2017, 5(8): 657-666. doi: 10.1016/S2213-2600(17)30214-X
|
| [4] |
中华医学会儿科学分会新生儿学组, 中华儿科杂志编辑委员会. 中国新生儿肺表面活性物质临床应用专家共识(2021版)[J]. 中华儿科杂志, 2021, 59(8): 627-632. doi: 10.3760/cma.j.cn112140-20210329-00261
|
| [5] |
中华医学会儿科学分会新生儿学组, 《中华儿科杂志》编辑委员会. 新生儿肺动脉高压诊治专家共识[J]. 中华儿科杂志, 2017, 55(3): 163-168.
|
| [6] |
CAREY W A, COLBY C E. Extracorporeal membrane oxygenation for the treatment of neonatal respiratory failure[J]. Semin Cardiothorac Vasc Anesth, 2009, 13(3): 192-197. doi: 10.1177/1089253209347948
|
| [7] |
刘雪琴, 张卫星, 刘玉霞, 等. 俯卧位通气对新生儿呼吸机相关性肺炎的疗效[J]. 广东医学, 2015, 36(18): 2862-2864. https://www.cnki.com.cn/Article/CJFDTOTAL-GAYX201518035.htm
|
| [8] |
中华医学会重症医学分会重症呼吸学组. 急性呼吸窘迫综合征患者俯卧位通气治疗规范化流程[J]. 中华内科杂志, 2020, 59(10): 781-787.
|
| [9] |
米洁, 黄桃, 高西. 俯卧位通气在急性呼吸窘迫综合征中的应用及护理干预研究[J]. 重庆医学, 2017, 46(14): 1904-1906. https://www.cnki.com.cn/Article/CJFDTOTAL-CQYX201714011.htm
|
| [10] |
徐军, 于学忠. ARDS与俯卧位通气[J]. 中国急救医学, 2004, 24(6): 430-432. https://www.cnki.com.cn/Article/CJFDTOTAL-ZJJY200406023.htm
|
| [11] |
RICHTER T, BELLANI G, SCOTT HARRIS R, et al. Effect of prone position on regional shunt, aeration, and perfusion in experimental acute lung injury[J]. Am J Respir Crit Care Med, 2005, 172(4): 480-487. doi: 10.1164/rccm.200501-004OC
|
| [12] |
LUKS A M. Ventilatory strategies and supportive care in acute respiratory distress syndrome[J]. Influ Other Respir Viruses, 2013, 7(Suppl 3): 8-17.
|
| [13] |
MACKENZIE C F. Anatomy, physiology, and pathology of the prone position and postural drainage[J]. Crit Care Med, 2001, 29(5): 1084-1085.
|
| [14] |
吕光宇, 蔡天斌, 蒋文芳, 等. VV-ECMO单用与联用俯卧位通气在急性呼吸窘迫综合征治疗中的疗效比较[J]. 中华危重病急救医学, 2021, 33(3): 293-298.
|
| [15] |
CURLEY M A Q, HIBBERD P L, FINEMAN L D, et al. Effect of prone positioning on clinical outcomes in children with acute lung injury: a randomized controlled trial[J]. JAMA, 2005, 294(2): 229-237.
|
| [16] |
雷光锋, 张雪晴, 张素霞. ALI/ARDS患者俯卧位与仰卧位通气的Meta分析[J]. 护理学杂志, 2016, 31(22): 87-92. https://www.cnki.com.cn/Article/CJFDTOTAL-HLXZ201622039.htm
|
| [17] |
SUD S, FRIEDRICH J O, ADHIKARI N K, et al. Effect of prone positioning during mechanical ventilation on mortality among patients with acute respiratory distress syndrome: a systematic review and meta-analysis[J]. CMAJ, 2014, 186(10): E381-E390.
|
| 1. |
柴春艳，王婷. 老年肺隐球菌感染临床分析并文献复习. 临床误诊误治. 2023(02): 1-4+10 .
|
© 2020 《实用临床医药杂志》编辑部
Address: 江苏省扬州市江阳中路136号，扬州大学江阳路北校区14号楼201室China Pos: 225009Tel: 0514-87978917、87978989、87978807
Supported by:
Beijing Renhe Information Technology Co., Ltd.
苏公网安备 32100302010246号
DownLoad: