俯卧位(新)解说.pptx

;;急性呼吸窘迫综合征的肺形态学改变;病变的非均一性;病变不均一性对机械通气效果的影响;Use of? extreme? position ?changes? in? acute?respiratory failure. Piehl MA ，Brown RS Crit Care Med .1976 Jan-Feb;4(1):13-4. DISCUSSION The data from this preliminary study suggest that 180-degrees changes in position favorably altered PaO2 values and improved mechanical toilet . Presumably the increase in PaO2 of 47 torr was achieved by reduction of the alveolar-arterial oxygen gradient with improvement in ventilation-perfusion rations ;俯卧位通气能显著改善ARDS患者氧合;;俯卧位通气时肺内血流的分布;俯卧位改善气体分布的均一性;Prone position augments recruitment and prevents alveolar overinflation in acute lung injury.; ;胸???压力在肺内的分布图;The?prone?position?eliminates?compression?of the?lungs?by the?heart. Am J Respir Crit Care Med.?2000 May;161(5):1660-5. ;俯卧位通气对呼吸机诱导肺损伤的影响;Prone?position?delays?the?progression?of?ventilator-induced?lung?injury?in?rats: does?lungstrain distribution play a role?;关于俯卧位通气的4篇RCT;2001年-2009年;prone ventilation reduces mortality in patients withe acute respiratory failure and severe hypoxemia :systematic review and meta -analysis ;;;主要和次要的临床转归;生存曲线：仰卧位和俯卧位;与之前研究的比较 纳入的ARDS患者病情更重 每日俯卧位通气时间明显延长：7-9h到17-18h 严格的肺保护性通气策略 经验丰富的团队;俯卧位通气治疗ARDS的指征;禁忌证和并发证;俯卧位通气操作;;;;;;;;;;;;;;;;;;;;;;;视频;病历介绍;入院情况;处理;CT变化（2015-06-05）;血气分析;CT变化（2015-06-12）;转归;小结;