Department of Pulmonary and Critical Care, John Hopkins School of Medicine, Baltimore, Maryland 212187, USA.
Respir Care. 2010 Jan;55(1):88-99.
Prone positioning has been known for decades to improve oxygenation in animals with acute lung injury and in most patients with acute respiratory distress syndrome (ARDS). The mechanisms of this improvement include a more uniform pleural-pressure gradient, a smaller volume of lung compressed by the heart, and more uniform and better-matched ventilation and perfusion. Prone positioning has an established niche as an intervention to improve gas exchange in patients with severe hypoxemia refractory to standard ventilatory manipulations. Because the lung may be more uniformly recruited and the stress of mechanical ventilation better distributed, prone positioning has also been proposed as a form of lung-protective ventilation. However, several randomized trials have failed to show improvements in clinical outcomes of ARDS patients, other than consistently better oxygenation. Because each of these trials had design problems or early termination, prone positioning remains a rescue therapy for patients with acute lung injury or ARDS.
俯卧位通气数十年来已被证实能够改善急性肺损伤动物和大多数急性呼吸窘迫综合征（ARDS）患者的氧合。这种改善的机制包括更均匀的胸膜压力梯度、受心脏压迫的肺体积更小、更均匀和更好匹配的通气和灌注。俯卧位通气作为一种干预措施，在严重低氧血症患者对标准通气操作无反应时，已经确立了改善气体交换的地位。由于肺可能更均匀地募集，机械通气的压力更好地分布，因此俯卧位通气也被提出作为一种肺保护通气的形式。然而，几项随机试验未能显示 ARDS 患者的临床结局得到改善，除了氧合持续改善外。由于这些试验中的每一个都存在设计问题或提前终止，俯卧位通气仍然是急性肺损伤或 ARDS 患者的抢救治疗方法。
