我在这里从另一个角度，也就是麻醉医师的基本功方面，开辟一个栏目。大家也许都能感觉到，书上内容很多，中文书条条框框很复杂，外文书滔滔不绝一大片。我科负责教育的 Dr. James Griffin 针对这个问题，把书上内容 “浓缩” 起来，做成卡片，分给住院医，实际上对主治医也是一个温故知新的作用。他的目的是让住院医生每日掌握一条信息。由于他讨论的几个问题，有连续性，我在这里把几个问题一起贴出，称其为 每周 一题。
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Nov 9 - Discuss hemodynamic & resp. effects of lateral decubitus positioning
侧卧位对呼吸和循环的影响：
Discussion points.
Placement of a patient in the lateral decubitus position can result in significant mismatching of pulmonary ventilation-to-perfusion during mechanical ventilation of the lungs for a number of reasons. First, while in the lateral position the mechanically ventilated patient has relatively better ventilation of the superior lung, while the dependent lung is being ventilated less. The reasons for the dependent lung being ventilated less are secondary to the loss of lung volume from compression by abdominal contents, mediastinal contents, and the structures used to position the patient. The patient concurrently has better perfusion of the dependent lung, primarily secondary to the effects of gravity. Together, these factors result in greater mismatching of ventilation and perfusion of the lungs during mechanical ventilation in a patient in the lateral decubitus position. Clinically, this may manifest as arterial hypoxemia.
Placement of a patient in the lateral decubitus position can result in compression of the inferior vena cava from the pressure of a kidney rest. This can lead to a decrease in venous return to the heart.
