Chatte G, Sab J M, Dubois J M, Sirodot M, Gaussorgues P, Robert D
Service de Réanimation Medicale et Assistance Respiratoire, Hopital dela Croix Rousse, Lyon, France.
Am J Respir Crit Care Med. 1997 Feb;155(2):473-8. doi: 10.1164/ajrccm.155.2.9032181.
The purpose of this study was to characterize changes in oxygenation, expressed as PaO2/F(I)O2, when patients with severe acute respiratory failure (PaO2/F(I)O2 < 150), unrelated to left ventricular failure to atelectasis, were turned to and from a supine to prone position at 1- and 4-h intervals. Ventilator settings were unchanged. Thirty-two consecutive patients were studied 1 h before, 1 and 4 h during and 1 h after placing in a prone position with PaO2/F(I)O2 of 103 +/- 28, 158 +/- 62, 159 +/- 59, and 128 +/- 52, respectively (ANOVA, p < 0.001). After 1 h in a prone position, improvement of PaO2/F(I)O2 by 20 mm Hg or more was considered a positive response. Seven patients studied had no response (22%), hereafter referred to as nonresponders, and 25 had a positive response (78%), hereafter referred to as responders. Among the seven nonresponders, two did not tolerate the prone position and were returned supine before the end of the 4-h trial. With the remaining five, PaO2/F(I)O2 evolution was 83 +/- 29, 77 +/- 19, 83 +/- 33, and 81 +/- 47, respectively. For two of the 25 responders, measurements are missing after returning to the supine position. In 10 of the 23 responders (43%) who completed the 4 h prone trial, the PaO2/F(I)O2 returned to its starting value when patients were repositioned supine: 117 +/- 24, 164 +/- 44, 156 +/- 55, and 110 +/- 34, respectively (ANOVA, p < 0.01). In 13 of the 23 (57%) improvement persisted: 105 +/- 27, 187 +/- 58, 189 +/- 49, and 157 +/- 49, respectively (ANOVA, p < 0.001). Repeated improvements after turning to a prone position were frequently observed. Side effects in the 32 patients after a total of 294 periods in a prone position included minor skin injury and edema, two instances of apical atelectasis, one catheter removal, one catheter compression, one extubation, and one transient supraventricular tachycardia.
本研究的目的是，在与左心室衰竭或肺不张无关的严重急性呼吸衰竭（PaO2/F(I)O2 < 150）患者中，以PaO2/F(I)O2表示的氧合变化特征，这些患者每隔1小时和4小时从仰卧位转为俯卧位再转回仰卧位。通气机设置不变。连续32例患者在俯卧位前1小时、俯卧位期间1小时和4小时以及俯卧位后1小时进行研究，PaO2/F(I)O2分别为103±28、158±62、159±59和128±52（方差分析，p < 0.001）。俯卧位1小时后，PaO2/F(I)O2改善20 mmHg或更多被视为阳性反应。研究的7例患者无反应（22%），以下称为无反应者，25例有阳性反应（78%），以下称为有反应者。在7例无反应者中，2例不能耐受俯卧位，在4小时试验结束前转回仰卧位。其余5例患者的PaO2/F(I)O2变化分别为83±29、77±19、83±33和81±47。在25例有反应者中的2例，转回仰卧位后测量数据缺失。在完成4小时俯卧试验的23例有反应者中的10例（43%）中，患者转回仰卧位时，PaO2/F(I)O2恢复到起始值：分别为117±24、164±44、156±55和110±34（方差分析，p < 0.01）。在23例中的13例（57%）中改善持续存在：分别为105±27、187±58、189±49和157±49（方差分析，p < 0.001）。经常观察到转为俯卧位后反复改善的情况。32例患者在总共294个俯卧位时间段后的副作用包括轻微皮肤损伤和水肿、2例肺尖肺不张、1例导管拔除、1例导管受压、1例拔管和l例短暂性室上性心动过速。
