Akatsuka Masayuki, Tatsumi Hiroomi, Yama Naoya, Masuda Yoshiki
Department of Intensive Care Medicine, Sapporo Medical University School of Medicine, Sapporo, Hokkaido, Japan.
Department of Anaesthesiology, Sapporo Medical University School of Medicine, Sapporo, Hokkaido, Japan.
J Crit Care Med (Targu Mures). 2020 Jan 31;6(1):32-40. doi: 10.2478/jccm-2020-0003. eCollection 2020 Jan.
In Acute Respiratory Distress Syndrome (ARDS), the heterogeneity of lung lesions results in a mis-match between ventilation and perfusion, leading to the development of hypoxia. The study aimed to examine the association between computed tomographic (CT scan) lung findings in patients with ARDS after abdominal surgery and improved hypoxia and mortality after prone ventilation.
A single site, retrospective observational study was performed at the Sapporo Medical University School of Medicine, Sapporo, Hokkaido, Japan, between 1st January 2004 and 31st October 2018. Patients were allocated to one of two groups after CT scanning according to the presence of ground-glass opacity (GGO) or alveolar shadow with predominantly dorsal lung atelectasis (DLA) on lung CT scan images. Also, Patients were divided into a prone ventilation group and a supine ventilation group when the treatment for ARDS was started.
We analyzed data for fifty-one patients with ARDS following abdominal surgery. CT scans confirmed GGO in five patients in the Group A and in nine patients in the Group B, and DLA in 17 patients in the Group A and nine patients in the Group B. Both GGO and DLA were present in two patients in the Group A and nine patients in the Group B. Prone ventilation significantly improved patients' impaired ratio of arterial partial pressure of oxygen to fraction of inspired oxygen from 12 h after prone positioning compared with that in the supine position. Weaning from mechanical ventilation occurred significantly earlier in the Group A with DLA vs the Group B with DLA (P < 0.001). Twenty-eight-day mortality was significantly lower for the Group A with DLA vs the Group B with DLA (P = 0.035).
These results suggest that prone ventilation could be effective for treating patients with ARDS as showing the DLA.
在急性呼吸窘迫综合征（ARDS）中，肺部病变的异质性导致通气与灌注不匹配，进而引发缺氧。本研究旨在探讨腹部手术后ARDS患者的计算机断层扫描（CT扫描）肺部表现与俯卧位通气后缺氧改善及死亡率之间的关联。
于2004年1月1日至2018年10月31日在日本北海道札幌市的札幌医科大学医学院进行了一项单中心回顾性观察研究。根据肺部CT扫描图像上是否存在磨玻璃影（GGO）或主要为背侧肺不张（DLA）的肺泡影，将患者在CT扫描后分为两组。此外，在开始治疗ARDS时，将患者分为俯卧位通气组和仰卧位通气组。
我们分析了51例腹部手术后发生ARDS患者的数据。CT扫描证实，A组有5例患者存在GGO，B组有9例患者存在GGO；A组有17例患者存在DLA，B组有9例患者存在DLA。A组有2例患者同时存在GGO和DLA，B组有9例患者同时存在GGO和DLA。与仰卧位相比，俯卧位通气从俯卧位12小时后显著改善了患者动脉血氧分压与吸入氧分数的受损比值。A组有DLA的患者与B组有DLA的患者相比，机械通气撤机明显更早（P < 0.001）。A组有DLA的患者28天死亡率显著低于B组有DLA的患者（P = 0.035）。
这些结果表明，俯卧位通气对治疗表现为DLA的ARDS患者可能有效。
