改良俯卧位通气对清醒病毒性肺炎患者呼吸循环、康复指标及并发症的影响OACSTPCD
Effect of Modified Prone Position Ventilation on Respiratory Circulation,Rehabilitation Indicators,and Complications in Conscious Patients with Vi-ral Pneumonia
目的 探讨改良俯卧位通气对清醒病毒性肺炎患者呼吸循环、康复指标、并发症的影响.方法 选取2021 年8 月—2023 年6 年就诊的134 例病毒性肺炎,按照随机数字表法分为研究组、对照组,各67 例,对照组采用常规俯卧位通气,研究组采用改良俯卧位通气.比较2 组康复指标、血气指标[氧合指数(PaO2/FiO2)、动脉血二氧化碳分压(PaCO2)、动脉血氧分压(PaO2)、血氧饱和度(SpO2)]、血流动力学指标[心率(HR)、中心静脉压(CVP)、平均动脉压(MAP)]、呼吸功能指标[平台压(Pplat)、气道峰压(Ppeak)、平均气道压(Pmean)]、炎症指标[白细胞介素-6(IL-6)、粒细胞-巨噬细胞集落刺激因子(GM-CSF)、肿瘤坏死因子-α(TNF-α)]、并发症及压力性损伤发生率.结果研究组住院时间短于对照组(P＜0.05);2 组俯卧 2、4、8、12、16 h PaCO2、PaO2、PaO2/FiO2、SpO2,以及俯卧 24、36h时Ppeak、Pmean、Pplat、GM-CSF、IL-6、TNF-α均较俯卧前得以明显改善(P＜0.05),但 2 组间比较差异无统计学意义(P＞0.05);2 组组间、组内不同时间点CVP、MAP、HR比较,差异无统计学意义(P＞0.05);研究组并发症总发生率2.99%(2/67)低于对照组11.94%(8/67),压力性损伤发生率2.99%(2/67)低于对照组13.43%(9/67)(P＜0.05).结论 在清醒病毒性肺炎患者中,改良俯卧位通气可达到与常规俯卧位通气相近的辅助治疗效果,能改善机体氧合功能、呼吸循环功能,降低并发症及压力性损伤发生风险,加速病情康复.
Objective To investigate the effects of modified prone position ventilation(PPV)on respiratory circula-tion,rehabilitation indicators,and complications in conscious patients with viral pneumonia(VP).Methods In total,134 VP patients treated from August 2021 to June 2023 were selected and divided into research group(n=67)and control group(n=67)according to the random number table method.The control group received conventional PPV,while the research group re-ceived modified PPV.The rehabilitation indicators,blood gas indicators[oxygenation index ratio of arterial partial pressure(PaO2)of oxygen to fractional inspired oxygen(PaO2/FiO2),arterial partial pressure of carbon dioxide(PaCO2),blood oxy-gen saturation(SpO2)],hemodynamic indicators[heart rate(HR),central venous pressure(CVP),mean arterial pressure(MAP)],respiratory function indicators[plateau pressure(Pplat),airway peak pressure(Ppeak),mean airway pressure(Pmean)],inflammatory indicators[interleukin-6(IL-6),granulocyte-macrophage colony stimulating factor(GM-CSF),tumor necrosis factor-α(TNF-α)],complications,and incidence of pressure injury were compared between the two groups.Results The length of hospitalization was shorter in the research group than in the control group(P＜0.05).The PaCO2,PaO2,PaO2/FiO2,SpO2 at 2,4,8,12,and 16 h in prone position,as well as Ppeak,Pmean,Pplat,GM-CSF,IL-6,and TNF-α at 24 and 36 h in prone position,were significantly improved compared with those before prone position in both groups(P＜0.05),which,however,showed no significant difference(P＞0.05).There was no significant intergroup and intra-group difference in CVP,MAP,and HR at different time points(P＞0.05).The total incidence of complications was lower in research group than in control group[2.99%(2/67)vs.(11.94%(8/67))],and the incidence of pressure injury was lower than that of control group[2.99%(2/67)vs.(13.43%(9/67)](P＜0.05).Conclusion In conscious patients with VP,modified PPV can achieve similar auxiliary therapeutic effects as conventional PPV,improve oxygenation and respir-atory circulation functions,reduce the risk of complications and pressure injury,and accelerate the recovery of the disease.
姚娜;柳娟娟;张婷婷
075000 河北 张家口,张家口市第一医院呼吸与危重症医学一科
临床医学
肺炎,病毒性改良俯卧位通气血气分析血流动力学白细胞介素-6肿瘤坏死因子-α平均气道压并发症
Pneumonia,viralModified prone position ventilationBlood gas analysisHemodynamicsInterleukin-6Tumor necrosis factor-αMean airway pressureComplications
《临床误诊误治》 2024 (006)
24-29 / 6
张家口市重点研发计划项目(2322043D)
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