Prone position ameliorates lung elastance and increases functional residual capacity independently from lung recruitment.
Prone position ameliorates lung elastance and increases functional residual capacity independently from lung recruitment.
复制标题
俯卧的位置可以改善肺弹性，并独立于肺部募集而增加功能性残留能力。
DOI：
10.1186/s40635-015-0055-0
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发表时间：
2015-12
影响因子：
3.5
通讯作者：
Gattinoni L
中科院分区：
文献类型：
--
作者：
Santini A;Protti A;Langer T;Comini B;Monti M;Sparacino CC;Dondossola D;Gattinoni L
在严重急性呼吸窘迫综合征期间，俯卧位用于恢复塌陷的依赖性肺区域，改善肺弹性和肺气体含量。我们假设，在没有肺复张的情况下，与仰卧位相比，俯卧位不会导致肺机械特性或气体含量的任何改善。10只健康猪在全身麻醉和麻痹状态下，在仰卧位和俯卧位下进行呼吸系统、胸壁和肺的压力-容积曲线，测量各自的弹性。在两个位置进行肺部计算机断层扫描（CT），以计算气体含量（即功能残气量（FRC））和通气分布。复张定义为非充气肺组织相对于肺总重量的百分比变化。在两种体位下，非充气（可复张）肺组织占总肺组织重量的百分比很小（4 ± 3 vs 1 ± 1%，仰卧vs俯卧，p = 0.004）。肺弹性降低（20.5 ± 1.8 vs 15.5 ± 1.6 cmH 2 O/l，仰卧vs俯卧，p < 0.001）和功能性残气量增加俯卧位（380 ± 82 vs 459 ± 60 ml，仰卧vs俯卧，p = 0.025）;比肺弹性无变化（7.0 ± 0.5 vs 6.5 ± 0.5 cmH 2 O，仰卧vs俯卧，p = 0.24）。肺复张较低（3 ± 2%），与功能残气量增加无关（R2 0.2，p = 0.19）。俯卧位时，肺组织通气良好的数量较多，通气不良的数量较少。在健康猪中，俯卧位通过肺通气的重新分布改善了肺的机械特性，并独立于肺募集增加了功能性残气量。
Prone position is used to recruit collapsed dependent lung regions during severe acute respiratory distress syndrome, improving lung elastance and lung gas content. We hypothesised that, in the absence of recruitment, prone position would not result in any improvement in lung mechanical properties or gas content compared to supine position. Ten healthy pigs under general anaesthesia and paralysis underwent a pressure–volume curve of the respiratory system, chest wall and lung in supine and prone positions; the respective elastances were measured. A lung computed tomography (CT) scan was performed in the two positions to compute gas content (i.e. functional residual capacity (FRC)) and the distribution of aeration. Recruitment was defined as a percentage change in non-aerated lung tissue compared to the total lung weight. Non-aerated (recruitable) lung tissue was a small percentage of the total lung tissue weight in both positions (4 ± 3 vs 1 ± 1 %, supine vs prone, p = 0.004). Lung elastance decreased (20.5 ± 1.8 vs 15.5 ± 1.6 cmH2O/l, supine vs prone, p < 0.001) and functional residual capacity increased (380 ± 82 vs 459 ± 60 ml, supine vs prone, p = 0.025) in prone position; specific lung elastance did not change (7.0 ± 0.5 vs 6.5 ± 0.5 cmH2O, supine vs prone, p = 0.24). Lung recruitment was low (3 ± 2 %) and was not correlated to increases in functional residual capacity (R2 0.2, p = 0.19). A higher amount of well-aerated and a lower amount of poorly aerated lung tissue were found in prone position. In healthy pigs, prone position ameliorates lung mechanical properties and increases functional residual capacity independently from lung recruitment, through a redistribution of lung aeration.