俯卧位通气在急性呼吸窘迫综合征中的 应用研究进展
Research Progress on the Application of Prone Position Ventilation in Acute Respiratory Distress Syndrome
DOI: 10.12677/acm.2026.1662370, PDF,   
作者: 潘 晗：佳木斯大学临床医学院，黑龙江 佳木斯；李树民*：佳木斯大学第一附属医院呼吸与危重症科，黑龙江 佳木斯
关键词: 急性呼吸窘迫综合征；俯卧位通气；机械通气；肺保护性通气；重症监护；Acute Respiratory Distress Syndrome； Prone Position Ventilation； Mechanical Ventilation； Lung-Protective Ventilation； Critical Care
摘要: 急性呼吸窘迫综合征(ARDS)是一种严重的急性低氧性呼吸衰竭，与较高的发病率和死亡率相关，据报道死亡率在30%至40%之间。俯卧位通气(PPV)是肺保护性通气策略的重要组成部分，已被证实能显著改善中重度ARDS患者的氧合并降低死亡率。越来越多的证据表明，PPV通过多种机制发挥有益的生理作用，包括改善通气/血流比值、增强背侧肺复张以及使跨肺压分布更加均匀，从而减少呼吸机相关性肺损伤。本文综述了目前对PPV生理机制的认识，并探讨了其临床适应症、实施策略、潜在并发症和护理管理注意事项。此外，本文还重点介绍了特定临床场景下的最新进展，包括在ARDS中使用正压通气(PPV)、在非插管患者中采用清醒俯卧位通气(APP)、延长俯卧位通气策略、在肥胖患者中的应用以及与体外膜肺氧合(ECMO)联合应用。更好地了解俯卧位通气的最佳时机、持续时间和患者选择，可能有助于进一步改善ARDS患者的预后。
Abstract: Acute respiratory distress syndrome (ARDS) is a severe form of acute hypoxemic respiratory failure associated with substantial morbidity and mortality, with reported mortality rates ranging from 30% to 40%. Prone position ventilation (PPV), an essential component of lung-protective ventilation strategies, has been shown to significantly improve oxygenation and reduce mortality in patients with moderate-to-severe ARDS. Accumulating evidence indicates that PPV exerts beneficial physiological effects through several mechanisms, including improved ventilation-perfusion matching, enhanced dorsal lung recruitment, and a more homogeneous distribution of transpulmonary pressure, thereby reducing ventilator-induced lung injury. This review summarizes the current understanding of the physiological mechanisms underlying PPV and discusses its clinical indications, implementation strategies, potential complications, and nursing management considerations. In addition, recent advances in specific clinical scenarios are highlighted, including the use of PPV in ARDS, the use of awake prone positioning (APP) in non-intubated patients, prolonged prone ventilation strategies, its application in obese patients, and its combination with extracorporeal membrane oxygenation (ECMO). A better understanding of the optimal timing, duration, and patient selection for prone positioning may help further improve the prognosis of patients with ARDS.
文章引用：潘晗, 李树民. 俯卧位通气在急性呼吸窘迫综合征中的 应用研究进展[J]. 临床医学进展, 2026, 16(6): 1560-1568. https://doi.org/10.12677/acm.2026.1662370

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