Background:Sepsis is a life-threatening condition marked by excessive inflammation and immune dysregulation. Macrophages are central to this process. Podoplanin (PDPN), a transmembrane glycoprotein, is upregulated in inflammatory macrophages, but its role in sepsis remains unclear. Objective:The aim of this study is to investigate the role of PDPN and the therapeutic potential of its monoclonal antibody SZ168 in LPS-induced macrophages and to extend these observations with supplementary in vivo and preliminary clinical validation. Methods:RAW264.7 macrophages were stimulated with LPS and treated with SZ168. PDPN expression and the effects of SZ168 on cytokine secretion, polarization, apoptosis, and ERK signaling were assessed by proteomics, qPCR, Western blotting, ELISA, and flow cytometry. siRNA-mediated PDPN knockdown was used to validate pathway dependence. During revision, additional Western blot validation of MEK, p90RSK, and c-Fos; supplementary in vivo experiments in a mouse sepsis model; and a preliminary clinical cohort analysis were incorporated to strengthen mechanistic and translational relevance. Results:LPS stimulation significantly upregulated PDPN expression at both mRNA and protein levels in macrophages. SZ168 treatment reduced LPS-induced secretion of IL-6, TNF-α, and IL-1β; promoted anti-inflammatory polarization; and attenuated apoptosis. Revision-stage Western blot analyses further showed coordinated recovery of MEK, p90RSK, c-Fos, and p-ERK together with suppression of SERPINE1 after SZ168 treatment, especially in PDPN-knockdown cells. Supplementary in vivo experiments showed lower BUN, creatinine, inflammatory cytokines, and lung injury after SZ168 treatment. In a preliminary clinical cohort, serum PDPN levels were higher in patients with sepsis than in controls (23.81 ± 17.64 vs. 3.53 ± 0.58, p < 0.001). Conclusion:The PDPN monoclonal antibody SZ168 attenuates inflammatory responses, promotes anti-inflammatory macrophage polarization, and inhibits apoptosis through modulation of the ERK signaling pathway in LPS-induced macrophages. The supplementary in vivo and preliminary human data added during revision further support the translational relevance of PDPN as a therapeutic target in sepsis.

Objective: To investigate the impact of hand edema on weaning from mechanical ventilation among ICU patients. Methods: A nested case‐control study was conducted, collecting data from mechanically ventilated patients admitted to the ICU of Wuxi People’s Hospital from October 1, 2023, to January 31, 2024. Patients were monitored for the occurrence of hand edema within the first 7 days of ICU stay and their weaning outcomes were recorded to analyze the impact of hand edema on weaning success. Results: The study included 124 patients, 97 successfully weaned while 27 failed. The failed weaning group had higher ages (70.8 ± 10.5 years), SOFA scores (17.7 ± 3.1), and levels of hand edema (Grade 0 in 6 patients, Grade 1 in 9, Grade 2 in 6, Grade 3 in 3, and Grade 4 in 3) compared with the successful weaning group (ages 61.1 ± 9.8 years, SOFA scores 14.3 ± 3.1, hand edema levels: Grade 0 in 78, Grade 1 in 15, Grade 2 in 3, Grade 3 in 1, and Grade 4 in 0). Multivariable binary logistic regression analysis indicated that the level of hand edema is an independent risk factor for weaning failure within 1 week in ICU patients on mechanical ventilation (OR = 3.209, 95% CI: 1.641–6.274, and p < 0.05). Conclusion: The occurrence of hand edema in ICU patients on mechanical ventilation increases the risk of weaning failure.

Background: This study aimed to elucidate the effect and underlying molecular mechanisms of SZ168 (Podo-planin (PDPN) monoclonal antibody) on lipopolysaccharide (LPS)-induced acute lung injury (ALI) mice and LPS-induced MH-S cells. Methods: The survival rate was calculated by recording the death of mice in each group. Enzyme linked immunosorbent assay (ELISA) was used to detect the levels of interleukin (IL)-6 and tumor necrosis factor-alpha (TNF-alpha) in blood and bronchoalveolar lavage fluid (BALF) of mice. Hematoxylin-eosin (H&E) staining were performed to evaluate the pathological changes in pulmonary tissues. Additionally, the phagocytosis of cells was tested by flow cytometry, and the expression levels of caveolin-1 (CAV-1) and Occludin proteins in lung tissue and the expression of nuclear factor-kappa B (NF-kappa B) and mitogen-activated protein kinase (MAPK) pathway-related proteins in MH-S cells were determined by western blot. Results: SZ168 significantly improved the survival rate of ALI mice. Briefly speaking, SZ168 protected pulmonary vascular permeability, reduced the level of pro-inflammatory cytokines, improved the pathological changes of lung tissue, reduced the infiltration of inflammatory cells, increased CAV-1 and Occludin protein expression, and then effectively relieved lung injury. In addition, SZ168 could significantly reduce the phagocytic ability of LPS-induced MH-S cells and inhibit the expression of hospho-extracellular regulated protein kinases (p-ERK), Phospho-Jun N-terminal kinase (p-JNK), Phospho-NF-kappa B p65 (p-p65) and Phospho-IkappaB-alpha (p-I kappa B alpha). Conclusion: SZ168 can treat ALI by inhibiting the activation of NF-kappa B and MAPK signaling pathways and restoring tight junction protein expression.

目的 研究血浆中可溶性平足蛋白(soluble podoplanin,sPDPN)对老年脓毒症性肺损伤病人早期诊断、病情分级、预后评估的价值.方法 选取 2018 年 1 月至 2020 年 12 月收住无锡市人民医院ICU的老年脓毒症病人共 95 例,分为脓毒症组(40 例)和脓毒症肺损伤组(55 例).将脓毒症肺损伤病人根据病情细分为脓毒症合并急性呼吸窘迫综合征(ARDS)亚组(脓毒症伴有ARDS,29 例)和脓毒性休克合并ARDS亚组(脓毒性休克伴有ARDS,26 例);根据病人的 28d转归情况分为存活亚组(40 例)和死亡亚组(15 例).对照组为同期健康体检老年人 30 例.观察并记录病人收入ICU当日一般情况及APACHEⅡ评分、序贯性器官功能衰竭(SOFA)评分、血管外肺水(EVLW);测定各组病人CRP、PCT、IL-6、TNF-α和sPDPN等指标.结果 sPDPN及CRP、PCT、IL-6、TNF-α水平和SOFA、APACHEⅡ评分在脓毒症肺损伤组、脓毒症组和对照组间,及各亚组间差异均具有统计学意义(P＜0.05).在各组别中,sPDPN与上述炎症指标、EVLW、SOFA评分及APACHEⅡ评分均呈正相关(P＜0.05).sPDPN预测病人 28d转归的ROC曲线下的AUC为 0.867.结论 在老年脓毒症病人发生ARDS时的早期诊断、病情分级和预后评估以及可能的治疗靶点选择方面,sPDPN是一个具有潜在价值的靶点.

Abstract A decrease of plasma fibrinogen level has occasionally been observed during tigecycline treatment. The present observational retrospective study was performed to analyze the effect of tigecycline on coagulation function in critically ill patients with multidrug-resistant bacterial infections, especially on plasma fibrinogen level. 83 adult subjects treating with tigecycline were enrolled. Coagulation function spanning all three time periods (berore, during and after tigecycline administration) was determined to measure the effects of tigecycline. A striking decrease of fibrinogen was noted during tigecycline treatment (P=0.000), and this change started to reverse when tigecycline was stopped. In the higher-dose group, fibrinogen also dropped significantly during tigecycline treatment (P=0.009), and after the cessation of tigecycline, the fibrinogen level did not rebound, but kept on drop. The fibrinogen levels dropped significantly in the 4 patients developed new-onset bleeding during tigecycline treatment, showing almost simultaneously. There were increased prothrombin time (PT), activated partial thromboplastin time (APTT), thrombin time (TT), platelet count (PLT) and decreased platelet level during tigecycline treatment and a reversal when tigecycline was stopped, although only the difference of PT reached significance (P=0.043). Tigecycline induced fibrinogen decrease in critically ill patients with multidrug-resistant bacterial infections, and this change started to reverse when tigecycline was stopped.

目的 分析肝素结合蛋白(heparin binding protein,HBP)、N-末端B型利钠肽原(n-terminal pro-b-type natriuretic peptide,NT-proBNP)、序贯器官衰竭评分(sequential organ failure assessment,SOFA)对脓毒症休克预后的预测价值.方法 选取2018年10月—2020年10月在无锡市人民医院治疗的脓毒症休克患者80例,均进行血清HBP、NT-proBNP检测及SOFA评估.根据患者治疗后28 d的转归情况分为预后不良组与预后良好组.使用单因素及多因素Logistic回归分析评价HBP、NT-proBNP、SOFA评分是否为影响脓毒症休克患者预后的相关因素.ROC曲线评价HBP、NT-proBNP联合SOFA评分对脓毒症休克患者预后的预测效能.结果 80例脓毒症休克患者死亡率为40.00％;预后不良组急性生理和慢性健康评分(acute physiology and chronic health evaluationⅡ,APACHEⅡ)评分、SOFA评分、血乳酸(lactic acid,Lac)、降钙素原(procalcitonin,PCT)、C反应蛋白(c-reactive protein,CRP)、HBP、NT-proBNP均高于预后良好组(P<0.05),多因素Logistic回归分析显示以上均是影响脓毒症休克患者预后的独立危险因素(P<0.05).工作特征曲线(receiver operating characteristic curve,ROC)曲线评价HBP、NT-proBNP联合SOFA评分预测脓毒症休克预后的曲线下面积(AUC)为0.843,均高于HBP、NT-proBNP、SOFA评分单独预测的0.796、0.635、0.797.结论 HBP、NTproBNP、SOFA评分均是影响脓毒症休克患者预后的独立危险因素,三者联合对预后预测有较高的效能,可用于临床治疗的指导.

目的 探究去甲肾上腺素应用在脓毒症休克中的效果及对不良事件发生率的影响.方法 本次研究对象从2018年1月至2020年12月来我院就诊的脓毒症休克患者中选取80例,按照随机数表法,将这些患者分成观察组和对照组.对照组40例患者采用常规方法治疗,观察组的40例患者采用去甲肾上腺素治疗,探究两组患者的治疗效果、临床相关指标和不良反应情况.结果 观察组患者治疗效果优于对照组(P<0.05);观察组患者临床相关指标优于对照组(P<0.05);观察组患者不良反应情况与对照组无差异(P>0.05).结论 去甲肾上腺素应用在脓毒症休克中的效果显著,有利于提高治疗有效率,提高治疗效果,不产生额外的不良反应,安全性较高,值得临床推广使用.

Background: Sepsis is an organ dysfunction characterized by systemic inflammatory response. Micro(mi)ribonucleic acids take part in the regulation of the inflammatory response in many conditions. However, the role and mechanism of miR-106a and anoctamin 1 (ANO1) in the inflammatory response in sepsis remain largely unknown. Material/Methods: The serum samples were collected from 31 sepsis patients and healthy volunteers. Lipopolysaccharide (LPS)-treated RAW264.7 cells were used for the study in vitro. The inflammatory response was investigated via interleukin-6 and tumor necrosis factor-alpha levels using quantitative real-time polymerase chain reaction (qRT-PCR) and enzyme-linked immunosorbent assay. The expression abundances of miR-106a and ANO1 were detected via qRT-PCR or western blot. The target association between miR-106a and ANO1 was explored using dual-luciferase reporter analysis. Results: The inflammatory response was trigged in sepsis and LPS-treated RAW264.7 cells. miR-106a expression was enhanced and ANO1 declined in sepsis and LPS-treated RAW264.7 cells. Overexpression of ANO1 suppressed the inflammatory response and knockdown of ANO1 promoted the inflammatory response in RAW264.7 cells. ANO1 was directly targeted via miR-106a, and miR-106a reversed ANO1-mediated inflammatory inhibition in LPS-treated RAW264.7 cells. Conclusions: MiR-106a regulated LPS-induced inflammatory response by targeting ANO1 in RAW264.7 cells, indicating the potential value of miR-106a for treatment of inflammatory diseases, including sepsis.

OBJECTIVE:To observe the effects of abnormal body temperature and the area under temperature curve on the prognosis of patients with septic shock. METHODS:A retrospective cohort study was conducted. Patients with septic shock admitted to intensive care unit (ICU) of Wuxi People's Hospital Affiliated to Nanjing Medical University from September 2013 to June 2019 were enrolled. Data were obtained from the hospital case database, including the gender, age, infection source, the length of ICU stay, sequential organ failure assessment (SOFA) score, 21-day prognosis; within the first 24 hours and throughout the period in ICU, the maximum temperature (24 h Tmax, Tmax), lowest temperature (24 h Tmin, Tmin), and the temperature range (24 h Tmax-min, Tmax-min) were aggregated. The area under temperature curve when body temperature was higher than T (A> T), or lower than T (A< T), and area section between T1 and T2 (AT1-T2) was calculated respectively. Patients were divided into survival group and death group according to 21-day prognosis. Binary Logistic regression was used to analyze the effect of the above temperature indices on the prognosis. RESULTS:635 septic shock patients were enrolled in the study. 476 patients were survived and 159 died within 21 days. Compared with the survival group, the age, SOFA score were higher in the death group, while the length of ICU stay was shorter. There was no significant difference in gender or infection source between two groups. After adjusting for gender, age, the length of ICU stay and SOFA score, binary Logistic regression analysis showed that the increase of Tmax, decrease of Tmin, and increase of Tmax-min were risk factors for 21-day mortality [Tmax: odds ratio (OR) = 2.959, 95% confidence interval (95%CI) was 1.620-5.398, P > 0.001; Tmin: OR = 0.329, 95%CI was 0.140-0.790, P = 0.012; Tmax-min: OR = 3.258, 95%CI was 1.840-5.471, P > 0.001], while 24 h Tmax, 24 h Tmin and 24 h Tmax-min were not related to prognosis. A< 36.0 centigrade (OR = 1.335, 95%CI was 1.102-1.745, P = 0.014), and A> 38.0 centigrade (OR = 1.041, 95%CI was 1.019-1.077, P = 0.001) showed positive correlation with 21-day mortality. When the T level was set at 38.0-40.0 centigrade, for every 1 centigrade×hour increase in A> T, the 21-day relative risk of death increased by 4.1%-83.2%. CONCLUSIONS:When the body temperature of patients with septic shock is lower than 36.0 centigrade, or higher than 38.0 centigrade, the 21-day relative risk of death rose with the increase of the magnitude and duration of abnormal body temperature.

目的:探讨早期肠内营养支持在脓毒症患者中的应用效果.方法:以60例脓毒症患者为观察对象,采用单双号抽签的方式分组实施研究,抽取到单号的32例患者采用肠外营养支持(对照组),抽取到双号的31例患者采用肠内营养支持(观察组),记录两组患者营养指标(白蛋白及血总蛋白),对比两组机械通气时间、抗生素使用时间、入住ICU时间、血糖最高值及7d降钙素原水平.结果:干预前,两组患者的营养指标经过SPSS20.0软件系统显示无明显差异(P>0.05);干预后,两组患者的营养指标经过SPSS20.0软件显示均得以提升,且观察组提升幅度更大(P<0.05);与对照组比较,观察组机械通气时间、抗生素使用时间更入住ICU时间更短,血糖最高值更低及7d降钙素原水平更低(P<0.05).结论:针对脓毒症患者,对其实施早期肠内营养支持可改善其营养状况,缩短机械通气时间、抗生素使用时间及入住ICU时间,降低血糖最高值及7d降钙素原水平,对疾病的康复有利.

目的 分析脓毒性休克伴心肌抑制患者的死亡风险.方法 入选2015～2016年入住ICU的脓毒性休克患者,射血分数(EF)<50％纳入心肌抑制组,EF≥50％纳入非心肌抑制组.比较两组患者入院6 h内CRP、PCT、Lac,入院24～48 h CRP、PCT、Lac、BNP、cTnI、SOFA评分、去甲肾上腺素平均剂量.多因素Cox风险回归法分析脓毒症患者死亡风险,并比较两组的死亡风险.结果 132例患者纳入研究,心肌抑制组24～48 h Lac、BNP、cTnI、SOFA评分、去甲肾上腺素平均剂量较非心肌抑制组高,差异有统计学意义(P<0.05).多因素Cox风险回归分析显示,入院24～48 h Lac、BNP、cTnI、SOFA评分、去甲肾上腺素平均剂量及心肌抑制是脓毒性休克患者死亡的危险因素,差异有统计学意义(P<0.05).其中心肌抑制组患者14 d死亡风险较非心肌抑制组增高95.2％,差异有统计学意义(P<0.05).分析14 d后存活患者1年内生存情况,两组差异无统计学意义.结论 心肌抑制患者14 d死亡风险增加95.2％.14 d后存活患者1年内死亡风险无差异.

Euthyroid sick syndrome (ESS) is commonly observed in various acute and chronic illness as risk factor for mortality in patients with severe diseases, with lower triiodothyronine (T3) and free triiodothyronine (fT3). To explore the relationship between disease severity and thyroid function in critically ill Chinese patients with ESS. A total of 51 patients admitted to intensive care unit were examined to determine acute physiology and chronic health assessment II (APACHE II) scores within 24 hours of admission; thyroid function tests (TSH, fT3, fT4, tT3, tT4) and rT3 levels were determined on the second day. Based on the test results, patients were divided into euthyroid (n=13), decreased fT3 or fT4 (n=17), and decreased TSH (n=21) groups. APACHE II scores and thyroid function were compared between the 3 groups. Furthermore, the relationship between the severity of disease and euthyroid sick syndrome was assessed. Out of 51 patients, 38 were men and 13 were women [mean age (+/- SD): 60.39 (+/- 19.32) years; range, 15-88 years]. APACHE II scores and rT3 levels were increased in all the 3 groups (P>.05). APACHE II scores showed a positive correlation with rT3 (P=.004, r=0.379). Critically ill Chinese patients with ESS have a poor health state. Higher rT3 values are associated with severe disease.

目的 本研究旨在研究和探讨血管性血友病因子(yon Willebrand factor,vWF)和含Ⅰ型血小板结合蛋白基序的解聚蛋白样金属蛋白酶(A disintegrin-like and metalloprotease with thrombospondin type 1 motif,vWF裂解酶,ADAMTS13)的活性在感染性休克和脓毒症患者早期及预后评估方面的临床意义.方法 选取2012-06～2013-06收住无锡市人民医院ICU的感染性休克或脓毒症患者40例,根据预后分为存活组20例和死亡组20例,记录其一般情况及入组时APACHEⅡ评分,于发病第1、3、5、7天分别运用ELISA法检测其血浆vWF活性及ADAMTS 13活性,各样本均数用方差分析、受试者工作特征(receiver operating characteristic,ROC)曲线分析、参数间进行Spearman相关分析,并绘制ROC曲线探讨vWF活性、ADAMTS13活性与APACHEⅡ评分之间的相关性.结果 死亡组的vWF活性均明显高于存活组(P＜0.05),ADAMTS13活性明显低于存活组(P＜0.05);同时死亡组APACHEⅡ评分明显高于存活组(P＜0.05);存活组在第3天vWF活性升高、ADAMTS13活性下降、APACHEⅡ评分升高,而在第5天和第7天又出现vWF活性持续下降、ADAMTS13活性持续升高、APACHEⅡ评分持续下降,死亡组则呈现vWF活性持续上升、ADAMTS13活性持续下降、APACHEⅡ评分持续升高(P＜0.05).40例患者的平均vWF活性与APACHEⅡ评分呈正相关(P＜0.01),而ADAMTS13活性与APACHEⅡ评分呈负相关(P＜0.01);ROC曲线分析,vWF活性和ADAMTS13活性AUC均接近于1,提示能很好地预测患者的预后(P＜0.01).结论 vWF活性、ADAMTS13活性均是判断感染性休克和脓毒症患者预后的可靠指标.在脓毒症的病理过程中,此二者数值的变化与疾病严重程度密切相关,即vWF活性的升高、ADAMTS13活性的降低预示了患者预后差.

ObjectiveTo research the differences of vWF,SP-D,IL-10,APC,TTS score in pulmonary contusion patients,to to explore its values of the early prediction of severity and prognosis in patients with pulmonary contusion.MethodsA total of 55 consecutive patients,December 2012 to November 2013 were enrolled. Clinical data of patients(including ISS、TTS score)and venous blood to detect vWF,SP-D,IL-10, APC were collected within 24 hours of admission.ResultsAmong these 55 patients,there were 35(63.7%)cases classified as ARDS. Significant differences in ISS,TTS,vWF,SP-D,IL-10,APC were found between ARDS group and non-ARDS group(P<0.05);The value in predicting ARDS when blood markers combined TTS score was the highest(AUC=0.877).ConclusionCombination of markers(vWF,SP-D,IL-10, APC)joint TTS score on admission has more predictive values in lung contusion patients occurring ARDS;TTS score predictes poor prognosis in pulmonary contusion patients and is suitable for severity assessment and prediction of outcome.

目的 探讨血乳酸清除率结合中心静脉氧饱和度(ScvO2)对指导感染性休克、脓毒症的液体复苏及疗效评估的意义.方法 收集2009-09~2012-03无锡市人民医院重症医学科(ICU)收治的脓毒症与感染性休克患者共60例,均于6 h内达到早期目标导向治疗(EGDT),根据6 h血乳酸清除率分为试验组(复苏后 6 h血乳酸清除率≥10%)31例和对照组(复苏后6 h血乳酸清除率<10%)29例.两组患者在复苏前及复苏后6、24、48 h分别进行急性生理学与慢性健康状况评分系统Ⅱ(APACHEⅡ评分),结合患者的机械通气时间、ICU住院时间及7 d和28 d病死率,比较两组患者的预后.结果 复苏后6、24、48 h试验组APACHEⅡ评分较对照组明显下降(P<0.05);试验组机械通气时间、ICU住院时间及28 d病死率均低于对照组(P<0.05),但两组7 d病死率差异无统计学意义.通过受试者工作特征曲线分析,复苏后6 h血乳酸清除率的曲线下面积为0.902±0.043(P<0.05).结论 血乳酸清除率结合ScvO2有助于综合评估脓毒症和感染性休克危重患者的疾病严重程度及预后,有效地指导治疗以早期改善感染性休克患者的组织缺氧状况,值得在临床上进行推广.

多发伤及胸部外伤常合并肺挫伤,严重肺挫伤并发急性呼吸窘迫综合征(ARDS)是患者死亡的主要原因之一.本文对肺挫伤并发ARDS的发生机制及治疗进行综述.研究表明,血流动力学改变、内皮损伤、炎症反应是肺挫伤发生ARDS的主要机制,对肺挫伤患者进行有效机械通气、液体复苏及清除炎症介质是早期防治ARDS的有效措施.

目的研究血必净注射液治疗感染性休克的临床效果。方法收集67例感染性休克患者随机分为血必净组32例和常规治疗组35例,两组均予常规治疗,在此基础上血必净组加用血必净注射液。观察两组入院时及治疗7 d后血乳酸水平、APACHEⅡ评分及第28日时临床疗效。结果治疗7 d后两组各项指标均较入院时显著改善,其中血必净组血乳酸水平、APACHEⅡ评分及有效率显著高于对照组。结论血必净注射液能显著改善感染性休克患者的病情及预后。

目的观察醒脑静注射液联合纳洛酮治疗急性脑出血临床疗效。方法将发病48h内的急性脑出血患者100例随机分为纳洛酮组(50例)与联合组(50例);比较两组治疗前、治疗后7d及14d Glasgow评分、NHISS评分及临床疗效。结果联合组Glasgow、NHISS评分及NHISS评分改善情况均明显优于纳洛酮组,显效率亦明显高于纳洛酮组。结论醒脑静注射液联合纳洛酮治疗脑出血能显著改善脑出血患者神经功能缺损。

Objective:To evaluate the effects of prone position ventilation combined with recruitment maneuvers(RM) on oxygenation and lung recruited volume (RV) in oleic acid-induced acute respiratory distress syndrome in canines. Methods:Twenty-four healthy canines were randomly divided into four groups after oleic acid-induced lung injury:supine position group (SC),supine position+RM group(SS),prone position group(PC) and prone position+RM group(PS). Oxygenation index and RV were measured for five hours after ARDS was reproduced. Results:(1)Compared to the SC group,oxygenation index in SS group was increased only at 2 h after onset of ARDS (P0.05),while that of PC and PS group improved both at 2 h and 5 h after onset of ARDS (all P0.05). Compared to the SC,SS,and PC group,PS group oxygenation index was much higher at 2 h and 5 h after onset of ARDS (all P0.05). (2)There was no significant difference of RV among the four group at 0 h after onset of ARDS(all P 0.05). Compared to the SC group,RV in SS,PC and PS group was much higher at 2 h after onset of ARDS (all P0.05). At 5 h after onset of ARDS,the RV of the SS group had a tendency to decrease while the RV of the PC and PS group had a tendency to increase. Conclusion:Prone position ventilation combined with RM improved oxygenation significantly. The increase of RV may be one of the most important mechanisms of its positire effect.