俯卧位机械通气对重症吸入性肺炎患者的疗效及安全性评估  

Evaluation of the efficacy and safety of prone position ventilation in patients with severe aspiration pneumonia

作　　者：张洪玲 李才辉[1] 黄玲 廖艳军 林天来[1] Zhang Hongling;Li Caihui;Huang Ling(The Quanzhou First Hospital Affiliated to Fujian Medical University Quanzhou,Fujian 362000)

机构地区：[1]福建医科大学附属泉州第一医院,福建泉州362000

出　　处：《基层医学论坛》2021年第1期5-7,共3页The Medical Forum

基　　金：泉州市科技计划项目(2018Z064)。

摘　　要：目的探讨俯卧位机械通气用于重症吸入性肺炎患者的疗效及安全性。方法选取2018年1月-2019年12月就诊于福建医科大学附属泉州第一医院重症医学科的174例重症吸入性肺炎患者作为研究对象,在接受相同常规治疗的基础上分别进行仰卧位机械通气和俯卧位机械通气。对比2组总住院时间、ICU住院时间、机械通气时间,APACHEⅡ评分及28 d生存率,并发症发生率。结果俯卧位机械通气组的总住院时间、ICU住院时间、机械通气时间均低于仰卧位机械通气组,但差异无统计学意义(P>0.05);而在机械通气后第7天,俯卧位机械通气组的APACHEⅡ评分显著低于仰卧位机械通气组,差异有统计学意义(P<0.05)。28 d生存曲线分析结果显示,仰卧位机械通气组和俯卧位机械通气组平均生存时间分别为(23.59±5.86)d和(23.71±6.76)d,无统计学差异(P>0.05);病死率分别为47.25%(43/91)和33.73%(28/83),无统计学差异(P>0.05)。仰卧位机械通气组和机械通气俯卧位组压力性损伤的发生率分别为32.97%和31.33%,均为组内发生率最高的并发症,但差异无统计学意义(P>0.05);俯卧位机械通气组水肿的发生率显著高于仰卧位机械通气组,差异有统计学意义(P<0.05);2组在心律失常、非计划性拔管、体位性低血压、反流性误吸等方面均无统计学差异(P>0.05)。结论俯卧位机械通气能够缩短重症吸入性肺炎患者疗程、延长生存时间、降低病死率,需提高对并发症的关注度。Objective By exploring the efficacy and safety of prone position ventilation in patients with severe aspiration pneumonia,more theoretical basis is provided for reasonable clinical diagnosis and treatment.Methods We recruited 174 patients with severe aspiration pneumonia in the Department of Intensive Medicine of the author’s hospital from January 2018 to December 2019,they were given supine position ventilation and prone position ventilation respectively on the basis of the same routine treatment.Results The time of total hospitalization,ICU hospitalization,and mechanical ventilation in the the group of prone position ventilation were lower than the group of supine position ventilation,but the difference was not statistically significant(P>0.05).The APACHE Ⅱ score in the the group of prone position ventilation was significantly lower than the group of supine position ventilation on the 7 th day after the mechanical ventilation,the difference was statistically significant(P<0.05).The 28-day survival curve showed that the average survival time in the group of supine position ventilation and prone position ventilation was(2.3.59±5.865) and(23.71 ± 6.763) days respectively,with no statistical significance(P>0.05).The mortality rate was 47.25%(43/91) and 33.73%(2.8/83) respectively,with no statistical significance(P>0.05).The incidence of pressure injury in the group of supine position ventilation and prone position ventilation was 32.97% and 31.33% respectively,which were the highest incidence complications in the group,but the difference was not statistically significant(P>0.05).The incidence of edema in the group of prone position ventilation was significantly higher than in the group of supine position ventilation,which was statistically significant(P<0.05).There were no statistically significant differences in arrhythmia,unplanned extubation,postural hypotension,and reflux aspiration between the groups(P>0.05).Conclusion The prone position ventilationc can shorten the course of treatment,prolong the surviv

关 键 词：吸入性肺炎 重症患者 机械通气 俯卧位 疗效 安全性 

分 类 号：R3[医药卫生—基础医学]