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中单在神经外科俯卧位手术体位摆放中的应用

Analysis of factors affecting enteral nutrition tolerance in patients accepting prone position ventilation

ObjectiveTo investigate the factors affecting enteral nutrition tolerance in patients accepting prone position ventilation.MethodsA retrospective study was conducted to analyze the tolerance of enteral nutrition in patients with prone position ventilation from January 2013 to December 2018. The single factor and multiple factors were used to analyze the influencing factors of enteral nutrition tolerance in patients accepting prone position ventilation.ResultsNinety-two patients who met the inclusion criteria were divided into 2 groups according to enteral nutrition tolerance table: 45 patients with good tolerance and 47 patients with poor tolerance. Univariate analysis showed age, use of muscle relaxants, albumin, prealbumin, feeding amount per unit time, acute physiology and chronic health evaluation Ⅱ (APACHEⅡ), sequential organ failure assessment (SOFA), nutrition risk in critically ill (NUTRIC) score and gastric residual volume were factors affecting the patient's tolerance (P<0.05). Logistic analysis showed that the factors affecting the patient's tolerance during the prone position were age, use of muscle relaxant, albumin, prealbumin, APACHEⅡ, SOFA, and NUTRIC scores (P<0.05).ConclusionFactors affecting enteral nutrition tolerance in patients accepting prone position ventilation are age, use of muscle relaxants, albumin, prealbumin, APACHEⅡ, SOFA and NUTRIC scores.

Analysis of influencing factors of the awake prone position in patients with mild and moderate acute respiratory distress syndrome

Objective To investigate the current status and influencing factors of the awake prone position in patients with mild and moderate acute respiratory distress syndrome (ARDS). Methods A total of 210 patients with mild to moderate ARDS admitted between December 2022 and January 2023 were investigated by general information questionnaire and self-made prone position knowledge questionnaire. The daily prone position time during hospitalization was recorded. The influencing factors of awake prone position were analyzed by univariate and multivariate linear regression. Results The 210 mild and moderate ARDS patients had an average daily prone position length of stay of (4.97±3.94)h/d, showing a low level. Multiple linear regression analysis showed that prone position knowledge score, age, waist circumference and BMI were the influencing factors of awake prone position (P<0.05). Conclusions Daily awake prone position length was at a low level in mild and moderate ARDS patients. Healthcare workers can prolong the time in the prone position by developing an individualized treatment plan for the prone position, improving the patient’s perception of the prone position, and resolving the discomfort from the prone position.

俯卧位通气治疗人感染 H7N9 禽流感致重度急性呼吸窘迫综合征二例报道

目的初步探索俯卧位通气（PPV）在人感染 H7N9 禽流感致重度急性呼吸窘迫综合征（ARDS）的疗效和安全性。方法收集福州肺科医院 RICU 2017 年 2 月至 4 月确诊人感染 H7N9 禽流感 2 例患者的 PPV 前 2 h（Pre-PPV），PPV 后 2 h、4 h、6 h、8 h、10 h、12 h（PPV-2 h、PPV-4 h、PPV-6 h、PPV-8 h、PPV-10 h、PPV-12 h），改为仰卧位通气（SPV）后 2 h、4 h（SPV-2 h、SPV-4 h）相关呼吸力学和血流动力学数据，利用 SPSS 19.0 软件进行分析。结果2 例均行有创机械通气；1 例 PPV 前纵隔气肿；症状出现至首次 PPV 分别为 5 d、8 d。共行 12 次 PPV，PPV 13（12～15）h/次，PPV 过程中（PPVmean）氧合指数（OI）较 Pre-PPV 改善［（186.20±71.34）mm Hg 比（131.36±45.43）mm Hg，P=0.020］；PPV 过程中（PPVmean）平均动脉压（MAP）较 Pre-PPV 有所下降［（86.84±10.17）mm Hg 比（97.58±20.51）mm Hg，P=0.009］。SPV 后（SPVmean）每小时尿量较 PPV 增多［（100.19±96.73）mL/h 比（52.96±21.64）mL/h，P=0.002］。与 Pre-PPV 对比，OI 以 PPV 10 h 和 12 h 改善为著（P 值分别为 0.009、0.040）。2 例均存活。PPV 过程中未发生深静脉置管滑脱、气管插管意外脱管、气管插管滑入一侧气管、气管插管阻塞。结论PPV 可改善人感染 H7N9 禽流感所致的重度 ARDS 患者的氧合功能，并发症少。

Application of prone position in the treatment of patients with acute respiratory distress syndrome caused by pulmonary contusion

ObjectiveTo explore the clinical significance of prone position in the treatment of patients with acute respiratory distress syndrome (ARDS) caused by pulmonary contusion.MethodsA retrospective analysis was conducted on pulmonary contusion patients in the Intensive Care Medicine (ICU) from January 2017 to April 2021. The patients were divided into a prone position group (n=121) and a control group (n=117) after screening. The patients' basic conditions, occurrence of ARDS (P/F<150 mm Hg), changes in vital signs, laboratory examinations, lung compliance and other changes after treatment, mechanical ventilation time, staying in ICU, complications, and mortality were recorded and conpared between the two groups.ResultsWhen ARDS [oxygenation index (P/F)<150 mm Hg] occurred, compared with 1 day later, the P/F [(125.7±15.3) vs. (209.5±22.4) mm Hg , P<0.05] and lung compliance [(64.6±4.8) vs. (76.0±5.4) mL/cm H2O, P<0.05] increased in the prone position group. Compare with the control group after 1 day of treatment ARDS (P/F<150 mm Hg), P/F [(209.5±22.4) vs. (126.1±19.5) mm Hg, P<0.05] and lung compliance [(76.0±5.4) vs. (63.5±5.5) mL/cm H2O, P<0.05] increased in the prone position group (P<0.05). Compare with the control group, the prone position group had shortened mechanical ventilation time and ICU stay time, less atelectasis, lower mortality (P<0.05), lower occurrence of pneumothorax (P>0.05).ConclusionProne position treatment for patients with pulmonary contusion after ARDS (P/F<150 mm Hg) can correct hypoxemia faster, improve lung compliance, reduce atelectasis, shorten mechanical ventilation time and stay time of ICU, and reduce mortality, hence it has clinical value.

重症加强治疗病房危重患者俯卧位通气垫的研制与使用

目的研制一种安全舒适、省时、省力、适合重症加强治疗病房（ICU）危重患者俯卧位通气的体位垫，解决 ICU 医护人员实施俯卧位通气护理操作带来的体位安置困难以及患者无法达到俯卧位通气时效性的问题，保障人工气道患者的安全，提高医护质量。方法俯卧位通气垫内层为高密度海绵、外层为聚氨酯皮包裹，通气垫一端底层装有拉链，由一个胸腹垫和 5 个组合垫组合而成，组合垫用于支撑头部和肢体。选择 2017 年 1 月至 2018 年 12 月入住联勤保障部队第九〇八医院重症医学科需进行俯卧位治疗的患者共 60 例，按照随机数字表法分为对照组和试验组各 30 例。对照组采用头部和胸部垫枕抬高的传统俯卧位方式，试验组采用俯卧位通气垫方式。结果俯卧位通气垫有良好的稳定性、缓冲性，有利于通气患者更好地实施俯卧位通气，人工气道无折叠弯曲，固定良好，脱管事件少。俯卧位通气期间压力性损伤发生率低。试验组俯卧位通气有效时间、体位安置时间、压力性损伤及呼吸机管路不良事件均显著优于对照组（P<0.05）。结论俯卧位通气垫制作简单、质地柔软。患者舒适、安全。医护人员实施俯卧位通气操作方便省力。通气垫易清洗、消毒，可有效预防交叉感染，适合 ICU 危重患者的俯卧位通气使用。

Efficacy of prone positioning ventilation in acute respiratory distress syndrome after acute Stanford type A aortic dissection surgery

Objective To explore the efficacy of prone positioning ventilation in patients with acute respiratory distress syndrome (ARDS) after acute Stanford type A aortic dissection (STAAD) surgery. Methods From November 2019 to September 2021, patients with ARDS who was placed prone position after STAAD surgery in the Xiamen Cardiovascular Hospital of Xiamen University were collected. Data such as the changes of blood gas, respiratory mechanics and hemodynamic indexes before and after prone positioning, complications and prognosis were collected for statistical analysis. ResultsA total of 264 STAAD patients had surgical treatment, of whom 40 patients with postoperative ARDS were placed prone position. There were 37 males and 3 females with an average age of 49.88±11.46 years. The oxygen partial pressure, oxygenation index and peripheral blood oxygen saturation 4 hours and 12 hours after the prone positioning, and 2 hours and 6 hours after the end of the prone positioning were significantly improved compared with those before prone positioning ventilation (P<0.05). The oxygenation index 2 hours after the end of prone positioning which was less than 131.42 mm Hg, indicated that the patient might need ventilation two or more times of prone position. Conclusion Prone position ventilation for patients with moderate to severe ARDS after STAAD surgery is a safe and effective way to improve the oxygenation.

Short-and Mid-term Outcomes of Patients with Esophageal Cancer after Subtotal Esophagectomy via Thoracoscopy in Lateral Prone Position, Left Lateral Position, or Prone Position: A randomized Controlled Trial

ObjectiveTo compare the short-and mid-term outcomes of patients with esophageal cancer after subtotal esophagectomy via thoracoscopy in lateral prone position, prone position, or left lateral position. MethodsThis randomized prospectively controlled study was conducted in 121 patients receiving subtotal esophagectomy via thoracoscopy between January 2010 and February 2013. The patients were randomly assigned into three groups to underwent esophagectomy in lateral prone position, prone position, or left lateral position, respectively. Forty-three patients (24 males, 19 females, 61.5±1.5 years) underwent surgery in lateral prone position, 39 patients (21 males, 18 females, 63.2±1.7 years) in prone position and other 39 patients (22 males, 17 females, 60.1±1.6 years) in left lateral position. Esophagogastric anastomosis was performed in the left neck. ResultsThe median operative time in the three groups was 232 (165-296) min, 230 (170-310) min, and 280 (190-380) min, respectively (P < 0.05). The median perioperative bleeding was 262 (185-330) ml, 275 (100-320) ml and 350 (120-560) ml, respectively (P > 0.05). The average number of harvested lymph nodes was 19.1 (9-26), 18.4 (11-23), 10.9 (6-21), respectively (P < 0.05). The postoperative medical complications occurred in 10, 9 and 11 patients in three groups, respectively, with no statistical difference. Twenty patients died in the lateral prone position group after a median follow-up period of 19.2 (6-31) months, 18 patients died in the prone position group after a median follow-up period of 20.7 (8-29) months, and 21 patients died in the left lateral position group after a median follow-up period of 18.5 (12-33) months. ConclusionThe results confirm the feasibility and safety of this minimally invasive esophagectomy via thoracoscopy in lateral prone position, prone position, or left lateral position for patients with esophageal carcinoma. A possible advantage of lateral prone technique is that in case of an emergency, precious time could be saved in changing the position of the patient.

Effect of prone position ventilation on patients with acute respiratory distress syndrome

ObjectivesTo investigate the effect of prone position ventilation (PPV) on patients with acute respiratory distress syndrome (ARDS).MethodsPatients with ARDS who received PPV treatment in the this hospital were enrolled from January 1, 2017 to December 31, 2017. The changes in heart rate, respiratory mechanics and blood gas index before and after PPV in patients, the inhaled oxygen concentration (FiO2), oxygenation index (PaO2/FiO2), pressure sore and other related complications were observed and compared in patients before and after PPV.ResultsA total of 28 patients with ARDS were registered, including 21 males and 7 females. Fourteen patients were complicated with chronic obstructive pulmonary disease (COPD) and 20 were dead in 28 days. After PPV, the peak pressure and plateau pressure decreased significantly, PaO2 and SaO2 increased significantly, system compliance improved considerably but PaCO2 did not change. There was no significant difference in the changes of heart reat, respiratory rate, minute volume, tidal volume and positive end-expiratory pressure between before and after PPV. FiO2 decreased significantly, PaO2/FiO2 increased significantly, and pressure sore increased significantly on day 1 post-PPV in comparison to pre-PPV and on day 7 post-PPV in comparison to day 1 post-PPV. A total of 13 unplanned extubation occurred during the entire PPV procedure, 9 of them were gastric tube slipping, 2 were urethral catheter slipping, 1 was tracheal tube slipping, and 1 was deep venous catheter slipping. There were 17 cases of artificial airway obstruction, 7 cases of hypotension, 3 cases of arrhythmia, and 4 cases of keratitis. In the subgroup analysis, the age of the patients complicated with COPD was significantly higher, but there was no difference in additional baseline data and the survival rate.ConclusionPPV can significantly improve the patient's respiratory status, especially oxygenation and respiratory mechanics, but PPV can increase the incidence of complications such as pressure sore, and PPV does not improve the prognosis.

Face-down posturing after idiopathic macular hole surgery: a meta-analysis

ObjectiveTo evaluate the full thickness idiopathic macular hole (IMH) closure rates in patients positioning non-supine (NSP) compared with patients positioning face-down (FDP). MethodsA computerized search was conducted in the PubMed, Chinese Biomedical Database, China National Knowledge Infrastructure, and VIP database. All the included studies were divided into NSP and FDP group. A total of 9 papers were included in this meta analysis, including 285 eyes (145 eyes with small hole ≤400 μm, 104 eyes with large hole >400 μm) in NSP group and 303 eyes (141 eyes with small hole and 124 eyes with large hole ). RevMan 4.2 software was applied for investigating heterogeneity and meta-analysis, and the risk of publication bias was evaluated. ResultsMeta analysis indicated that there was statistical significance on closure rates betwen NSP and FDP group. The difference of closure rates in small macular hole eyes between NSP and FDP group was statistically significant (OR=0.45, 95%CI 0.13-1.51;P=0.20). The difference of closure rates in large macular hole eyes between NSP and FDP group was statistically significant (OR=0.35, 95%CI 0.17-0.75;P=0.006). ConclusionNSP is equally effective as strict FDP in the repair of small macular hole. Post-operative FDP may improve the macular hole closure rates for holes larger than 400 μm.