早期清醒俯卧位联合经鼻高流量氧疗治疗重型新型冠状病毒肺炎一例  

Early waking prone position combined with HFNC oxygen therapy for severe COVID-19: a case report

作　　者：鲁卫华[1] 王涛[1] 秦雪梅[1] 徐前程 姜小敢[1] Weihua Lu;Tao Wang;Xuemei Qin;Qiancheng Xu;Xiaogan Jiang(Department of Critical Care Medicine,Yijishan Hospital,Wannan Medical College,Wuhu 241000,China)

机构地区：[1]皖南医学院弋矶山医院重症医学科,安徽芜湖241000

出　　处：《中华重症医学电子杂志》2022年第1期85-89,共5页Chinese Journal Of Critical Care & Intensive Care Medicine(Electronic Edition)

基　　金：安徽省中央引导地方科技发展专项项目(201907d07050001);皖南医学院弋矶山医院“高峰”培育计划(GF2019J03)。

摘　　要：在新型冠状病毒肺炎(简称“新冠肺炎”)疫情防控的早期阶段,由于对疾病的认识不足,重症患者治疗难度大、病死率高,这对ICU医师提出了挑战。皖南医学院弋矶山医院在疫情防控早期阶段收治1例重型新冠肺炎患者,结合既往急性呼吸窘迫综合征(ARDS)的处理经验,采用早期清醒俯卧位联合经鼻高流量氧疗(HFNC)治疗,成功避免气管插管和机械通气,最终患者康复出院。本文报告该病例的综合救治过程,并结合文献,分析清醒俯卧位联合HFNC治疗重型新冠肺炎的循证医学依据、注意事项和及时转为有创机械通气的时机,提出“俯卧位前移”的概念,为重症新冠肺炎患者救治提供有力的医疗决策。In the early stages of COVID-19 prevention and control, due to insufficient understanding of the disease, severe patients were difficult to treat and had a high mortality rate, which posed challenges to ICU physicians. One patient with severe COVID-19 was admitted to our hospital in the early stage of the outbreak. With experiences from the previous management of acute respiratory distress syndrome, the patient was treated with early waking prone position combined with high-flow nasal cannula (HFNC) oxygen therapy. Without endotracheal intubation and mechanical ventilation the patient recovered and was discharged. In this paper, we elaborate the prone position combined with HFNC oxygen therapy together with the comprehensive treatment process of this case. With literature review, we outline the evidence-based basis, notices and timing of invasive mechanical ventilation for awake prone position combined with HFNC in the treatment of severe COVID-19, and summarize the concept of “forward prone position”, which might help making a critical medical decision for the treatment of severe COVID-19 patients.

关 键 词：新型冠状病毒肺炎 急性呼吸窘迫综合征 清醒俯卧位 经鼻高流量氧疗 

分 类 号：R47[医药卫生—护理学]