目的:观察静脉-静脉体外膜肺氧合（VV-ECMO）联合俯卧位通气（PPV）对重度急性呼吸窘迫综合征（ARDS）患者氧合指数（PaOn 2/FiOn 2）、呼吸系统顺应性（Crs）、血管活性药物评分（VIS）的影响。n 方法:采用回顾性观察性研究方法，选择2018年6月至2020年4月柳州市人民医院收治的18例需要VV-ECMO支持的重度ARDS患者作为研究对象，其中8例在VV-ECMO后实施PPV。比较VV-ECMO组与VV-ECMO联合PPV组治疗前和治疗1、2、3 d，以及VV-ECMO联合PPV组实施PPV 3 d内每日开始PPV前和PPV治疗结束后2 h PaOn 2/FiOn 2、VIS、Crs的差异；并观察两组患者不良事件发生情况。n 结果:治疗前两组PaOn 2/FiOn 2、VIS比较差异均无统计学意义。随治疗时间延长，两组PaOn 2/FiOn 2、Crs均逐渐升高，VIS均逐渐降低，治疗1 d起PaOn 2/FiOn 2、VIS与治疗前比较差异有统计学意义〔PaOn 2/FiOn 2（mmHg，1 mmHg＝0.133 kPa）：VV-ECMO组为197.75±39.80比75.57±7.44，VV-ECMO联合PPV组为255.20±31.92比68.24±11.64；VIS（分）：VV-ECMO组为5.51±3.72比10.20±7.10，VV-ECMO联合PPV组为6.73±3.32比14.50±2.48，均n P<0.05〕，持续到治疗3 d〔PaOn 2/FiOn 2（mmHg）：VV-ECMO组为231.96±32.76比75.57±7.44，VV-ECMO联合PPV组为285.61±19.40比68.24±11.64；VIS（分）：VV-ECMO组为2.26±1.90比10.20±7.10，VV-ECMO联合PPV组为2.13±1.55比14.50±2.48，均n P<0.05〕，且治疗1 d和3 d VV-ECMO联合PPV组PaOn 2/FiOn 2均明显高于VV-ECMO组（mmHg：1 d为255.20±31.92比197.75±39.80，3 d为285.61±19.40比231.96±32.76，均n P<0.05）。治疗前VV-ECMO联合PPV组Crs明显低于VV-ECMO组（mL/cmHn 2O：17.91±0.82比20.54±1.26，n P<0.05）；VV-ECMO联合PPV组治疗1 d起Crs即明显高于治疗前（mL/cmHn 2O：21.20±1.50比17.91±0.82），治疗3 d达到峰值为（24.93±2.18）mL/cmHn 2O，但两组比较差异无统计学意义。VV-ECMO联合PPV组PPV1、2、3 d每日治疗后2 h PaOn 2/FiOn 2和Crs均较PPV治疗前明显升高，3 d时达到最高水平〔PaOn 2/FiOn 2（mmHg）：285.61±19.40比189.91±28.34，Crs（mL/cmHn 2O）：24.93±2.18比23.35±1.45，均n P<0.05〕，VIS仅PPV治疗1 d后2 h较PPV前明显升高（分：6.73±3.32比6.38±3.22，n P<0.05）。实施PPV后未发生与之相关的严重不良事件。n 结论:VV-ECMO期间联合PPV能更进一步提高PaOn 2/FiOn 2，可更好地改善低氧血症，并有利于实施进一步的保护性肺通气策略以减少机械通气的危害。此外，未发现严重的不良事件，PPV在VV-ECMO期间是安全的。n “,”Objective:To observe the effects of veno-venous extracorporeal membrane oxygenation (VV-ECMO)combined with prone position ventilation (PPV) on oxygenation index (PaOn 2/FiOn 2), respiratory compliance (Crs) and vasoactive inotropic score (VIS) in severe acute respiratory distress syndrome (ARDS) patients.n Methods:Eighteen patients with severe ARDS requiring VV-ECMO support in Liuzhou People's Hospital from June 2018 to April 2020 were selected for retrospective analysis, and 8 patients among of these cases received PPV after VV-ECMO. The differences in PaOn 2/FiOn 2, VIS and Crs before and 1, 2 or 3 days after treatment were compared between VV-ECMO group and VV-ECMO combined with PPV group, as well as the differences in these indices before PPV and 2 hours after PPV daily in VV-ECMO combined with PPV group. The incidence of adverse events in two groups were also observed.n Results:Before treatment, there was no significant difference in PaOn 2/FiOn 2, Crs between two groups. Over time, PaOn 2/FiOn 2 and Crs increased and VIS decreased in both groups. Compared with before treatment, there were statistically significant differences in PaOn 2/FiOn 2 and VIS from 1 day after treatment [PaOn 2/FiOn 2 (mmHg, 1 mmHg = 0.133 kPa): VV-ECMO group was 197.75±39.80 vs. 75.57±7.44, VV-ECMO combined with PPV group was 255.20±31.92 vs. 68.24±11.64; VIS: VV-ECMO group was 5.51±3.72 vs. 10.20±7.10, VV-ECMO combined with PPV group was 6.73±3.32 vs. 14.50±2.48, all n P < 0.05], up to 3 days after treatment [PaO n 2/FiOn 2 (mmHg): VV-ECMO group was 231.96±32.76 vs. 75.57±7.44, VV-ECMO combined with PPV group was 285.61±19.40 vs. 68.24±11.64; VIS: VV-ECMO group was 2.26±1.90 vs. 10.20±7.10, VV-ECMO combined with PPV group was 2.13±1.55 vs. 14.50±2.48, all n P < 0.05], and the PaO n 2/FiOn 2 1 day and 3 days after treatment in VV-ECMO combined with PPV group were significantly higher than those in VV-ECMO group (mmHg: after 1 day of treatment was 255.20±31.92 vs. 197.75±39.80, after 3 days of treatment was 285.61±19.40 vs. 231.96±32.76, both n P < 0.05). Before treatment, Crs of VV-ECMO combined with PPV group was significantly lower than that of VV-ECMO group (mL/cmH n 2O: 17.91±0.82 vs. 20.54±1.26, n P 0.05). In VV-ECMO combined with PPV group, compared with before PPV treatment, the PaO n 2/FiOn 2 and Crs of 2 hours after PPV treatment in 1, 2 and 3 days were significantly rose, and it reached the highest level in 3 days [PaOn 2/FiOn 2(mmHg): 285.61±19.40 vs. 189.91±28.34, Crs (mL/cmHn 2O): 24.93±2.18 vs. 23.35±1.45, both n P < 0.05]; the VIS was only increased in 2 hours after PPV treatment on the first day than before (6.73±3.32 vs. 6.38±3.22, n P < 0.05). There were no related serious adverse events happened after PPV treatment.n Conclusions:The combination of PPV during VV-ECMO could further increase PaOn 2/FiOn 2, improve hypoxemia and implement further protective lung ventilation to reduce the potential hazards during mechanical ventilation. In addition, no serious adverse events were observed in this study, suggesting PPV is safe during VV-ECMO.n