俯卧位通气策略在急性Stanford A型主动脉夹层术后重度急性呼吸窘迫综合征患者中的疗效分析

Efficacy Analysis of the Prone Position Ventilation Strategy in Patients with Severe Acute Respiratory Distress Syndrome after Acute Stanford Type A Aortic Dissection Surgery

摘要: 目的：探讨俯卧位通气策略(Prone Position Ventilation, PPV)在急性Stanford A型主动脉夹层(acute Stanford type A aortic dissection, STAAD)术后重度急性呼吸窘迫综合征(acute respiratory distress syndrome, ARDS)患者中临床应用的有效性及安全性。方法：回顾性分析2022年6月~2025年6月新疆医科大学第一附属医院重症医学中心收治STAAD术后并发重度ARDS且行PPV患者的临床资料，对患者的一般资料、实施俯卧位通气前后的血气分析指标、血流动力学指标、不良事件等进行统计学分析。结果：收集资料期间共有332例STAAD患者行心脏外科手术治疗，术后并发重度ARDS并实施PPV的患者共50例(15.1%)，其中男性40例，女性10例，平均年龄(48.68 ± 12.52)岁，50例患者经PPV治疗3天后，动脉血氧合指数(OI)较前明显改善(75.04 ± 7.44 mmHg vs. 291.16 ± 10.25 mmHg, P < 0.05)，PCO₂较前明显下降(52.84 ± 2.25 mmHg vs. 36.68 ± 0.85 mmHg, P < 0.05)，PPV期间血流动力学无明显变化，共有12例(24%)患者发生不良事件，其中5例发生颜面部浮肿，4例发生术区少量渗血，3例发生胸部皮肤压力性损伤，最终44例(88%)患者均顺利拔管转出ICU，好转后出院，6例(12%)患者因感染及多脏器功能衰竭死亡。结论：PPV治疗策略与STAAD术后重度ARDS患者的氧合改善相关，改善二氧化碳潴留，并且对血流动力学影响较小，配合针对性的管理措施，并发症是轻微、可逆、可防治的，是一种有效且安全的治疗策略。

Abstract: Objective: To explore the effectiveness and safety of the prone position ventilation strategy (PPV) in the clinical application for patients with severe acute respiratory distress syndrome (ARDS) after acute Stanford type A aortic dissection (STAAD) surgery. Methods: A retrospective analysis was conducted on the clinical data of patients with severe ARDS who underwent PPV after STAAD and were admitted to the Intensive Care Unit of the First Affiliated Hospital of Xinjiang Medical University from June 2022 to June 2025. Statistical analysis was performed on the general information of the patients, the blood gas analysis indicators before and after the implementation of prone position ventilation, hemodynamic indicators, and adverse events. Results: During the data collection period, a total of 332 STAAD patients underwent cardiac surgery treatment. Among them, 50 patients (15.1%) developed severe ARDS and underwent PPV after surgery. There were 40 male patients and 10 female patients, with an average age of (48.68 ± 12.52) years. After 3 days of PPV treatment, the arterial oxygenation index (OI) of the 50 patients significantly improved (75.04 ± 7.44 mmHg vs. 291.16 ± 10.25 mmHg, P < 0.05), and PCO₂ significantly decreased (52.84 ± 2.25 mmHg vs. 36.68 ± 0.85 mmHg, P < 0.05). There was no significant change in hemodynamics during PPV. A total of 12 patients (24%) experienced adverse events, including 5 cases of facial edema, 4 cases of minor bleeding at the surgical site, and 3 cases of pressure-induced skin injury on the chest. Eventually, 44 patients (88%) were successfully extubated and transferred out of the ICU, and discharged after improvement. Six patients (12%) died due to infection and multiple organ failure. Conclusion: The PPV treatment strategy is associated with improved oxygenation in patients with severe ARDS after STAAD surgery. It helps alleviate carbon dioxide retention and has a relatively minor impact on hemodynamics. When combined with targeted management measures, the complications are mild, reversible, and preventable, making it an effective and safe treatment strategy.