早期清醒俯卧位联合经鼻高流量氧疗对轻中度ARDS患者的研究  

Study of early awake prone position combined with high-flow nasal cannula for patients with mild to moderate ARDS

作　　者：张勤芹[1] 唐诚 缪翠维 李泉 ZHANG Qin-qin;TANG Cheng;MIAO Cui-wei;LI Quan(ICU,Nantong Hospital of TCM,Nantong,Jiangsu 226001,China;ICU,Suqian First Hospital,Suqian,Jiangsu 223800,China)

机构地区：[1]南通市中医院重症医学科,江苏南通226001 [2]宿迁市第一人民医院重症医学科,江苏宿迁223800

出　　处：《临床肺科杂志》2022年第6期858-861,共4页Journal of Clinical Pulmonary Medicine

基　　金：南通市中医医疗联盟课题(No.TZYK202005);南通市卫生健康委员会科研课题(No.QA2021024);宿迁市指导科技计划项目(No.Z2019145)。

摘　　要：目的观察早期清醒俯卧位(PP)联合经鼻高流量氧疗对轻中度ARDS患者氧合指数及插管率、病死率的影响。方法纳入南通市中医院、宿迁市第一人民医院重症医学科,2020年3月—2021年03月收治的89例肺炎引起的轻中度的ARDS患者,分层随机分组为对照组44例和俯卧位组45例。对照组采用HFNC支持,俯卧位组采用HFNC+PP。统计治疗过程中两组气管插管率,ICU住院时间、28天病死率,治疗第3、7天氧合指数、吸氧浓度,统计俯卧位组每日PP时间,不良反应。结果(1)俯卧位组较对照组气管插管率低(P<0.05),ICU住院时间减少(P<0.05),28天病死率无明显差异(P>0.05)。(2)治疗第3、7天,俯卧位组氧合指数高于同期对照组(P<0.05),吸氧浓度低于同期对照组(P<0.05)。(3)俯卧位组每日俯卧位时间平均12.19±2.19小时,不良反应较轻微,可控。结论早期在HFNC的基础上联合清醒俯卧位,能改善肺炎致轻中度ARDS患者的氧合指数,降低ARDS患者的气管插管率,对28天病死率无明显影响,在HFNC的基础上联合早期清醒俯卧位,患者耐受性良好,不良反应可控。Objective To observe the effect of early awake prone position(PP)combined with high-flow nasal cannula(HFNC)on oxygenation index,intubation rate and mortality of patients with mild to moderate ARDS.Methods This study was a two-center prospective randomized controlled study.A total of 89 patients with mild to moderate ARDS caused by pneumonia admitted to the ICU Department of Nantong Hospital of Traditional Chinese Medicine and Suqian First People’s Hospital from March 2020 to March 2021 were randomly divided into the control group(n=44)and the prone group(n=45).The control group was supported by HFNC,while the prone group was supported by HFNC+PP.The rate of endotracheal intubation,duration of ICU stay,28-day fatality rate,oxygenation index at the 3rd and 7th day of treatment in the two groups were counted.Daily PP time and adverse reactions in the prone group were counted.Results(1)Compared with the control group,the rate of tracheal intubation in the prone group was lower(P<0.05),the duration of ICU stay was shorter(P<0.05),the cost of ICU treatment was lower(P<0.05),but the 28-day mortality at had no significant difference(P>0.05).(2)On the 3rd and 7th days of treatment,the oxygenation index of the prone group was higher than that of the control group(P<0.05),and the fraction of inspiration O_(2) of the prone group was lower than that of the control group(P<0.05).(3)In the prone group,the average time of prone position was 12.19±2.19 hours per day,and the adverse reactions were mild and controllable.Conclusion Early treatment with HFNC combined with awake prone position can improve the oxygenation index of patients with mild to moderate ARDS caused by pneumonia,reduce the rate of endotracheal intubation,and have no significant effect on 28-day mortality.Patients received HFNC combined with awake prone position are well tolerated and have controllable adverse reactions.

关 键 词：急性呼吸窘迫综合征 早期清醒俯卧位 经鼻高流量氧疗 氧合指数 气管插管率 

分 类 号：R563.8[医药卫生—呼吸系统]