清醒俯卧位治疗用于奥密克戎变异株所致普通型新冠肺炎的临床研究  

Clinical study of awake prone positioning treatment in patients with common coronavirus disease 2019 caused by Omicron variant

作　　者：王志勇[1] 冯全胜[1] 于洪志[2] 史丽霞[2] 徐磊[1] Wang Zhiyong;Feng Quansheng;Yu Hongzhi;Shi Lixia;Xu Lei(Department of Critical Care Medicine,Tianjin Third Central Hospital,Tianjin Key Laboratory of Artificial Cell,Artificial Cell Engineering Technology Research Center of Public Health Ministry,Tianjin 300170,China;Department of Respiratory and Critical Care Medicine,Tianjin Haihe Hospital,Tianjin 300350,China)

机构地区：[1]天津市第三中心医院重症医学科,天津市人工细胞重点实验室,卫生部人工细胞工程技术研究中心,天津300170 [2]天津市海河医院呼吸与危重症医学科,天津300350

出　　处：《中华危重病急救医学》2022年第6期576-580,共5页Chinese Critical Care Medicine

基　　金：天津市科技计划项目(18ZXDBSY00100);天津市医学重点学科(专科)建设项目(2021-12)。

摘　　要：目的评价清醒俯卧位(APP)用于奥密克戎变异株所致普通型新冠肺炎的临床效果。方法回顾分析2022年1月8日至2月20日天津市第三中心医院医疗队支援天津市新冠肺炎定点医院期间收治的奥密克戎变异株所致新冠肺炎患者的临床资料,选择符合普通型新冠肺炎诊断标准,且具有重症高危因素或不吸氧情况下活动后脉搏血氧饱和度(SpO_(2))≤0.93的患者作为研究对象。根据患者入组后的前3 d是否完成每日12 h的APP,将患者分为APP组和对照组。评价两组患者的人口学特征、临床症状、新冠疫苗接种情况、实验室检查、疾病进展情况(进展为重症)、核酸转阴时间、住院时间以及APP期间的不良反应和耐受性〔视觉模拟量表(VAS)评分(评分越高,耐受性越差)〕;比较两组患者入组时、入组3 d、7 d的白细胞介素-6(IL-6)、C-反应蛋白(CRP)、SpO_(2)/吸入氧浓度(FiO_(2))比值、ROX指数(ROXI)。结果研究期间,APP组及对照组分别纳入95例和102例患者。两组患者的人口学特征、临床症状、新冠疫苗接种率、实验室检查比较差异均无统计学意义;两组患者入组时IL-6、CRP、SpO_(2)/FiO_(2)比值和ROXI比较差异均无统计学意义。与本组入组时相比,入组3 d时APP组SpO_(2)/FiO_(2)比值和ROXI均明显升高〔SpO_(2)/FiO_(2)比值:461.90(457.10,466.70)比446.67(437.14,457.10),ROXI:25.40(23.33,25.93)比22.57(21.86,24.40),均P<0.05〕,对照组IL-6和CRP水平均明显升高〔IL-6(ng/L):18.30(6.50,37.75)比7.40(5.10,11.15),CRP(mg/L):11.46(2.11,17.96)比4.11(1.72,9.05),均P<0.05〕。入组3 d时,APP组IL-6和CRP水平均明显低于对照组〔IL-6(ng/L):7.35(4.35,12.80)比18.30(6.50,37.75),CRP(mg/L):4.52(1.98,9.66)比11.46(2.11,17.96),均P<0.05〕,而SpO_(2)/FiO_(2)比值和ROXI均明显高于对照组〔SpO_(2)/FiO_(2)比值:461.90(457.10,466.70)比446.67(441.90,459.52),ROXI:25.40(23.33,25.93)比23.31(22.10,24.66),均P<0.05〕。入组7 d时,两组患者的IL-6、CRObjective To evaluate the clinical effect of awake prone positioning(APP)for common coronavirus disease 2019(COVID-19)caused by Omicron variant.Methods Retrospectively analyze the clinical data of patients with COVID-19 caused by Omicron variant admitted by medical team of Tianjin Third Central Hospital during the period of supporting Tianjin COVID-19 designated hospital from January 8 to February 20,2022.Patients who met the diagnostic criteria for common COVID-19 and had risk factors for developing severe disease or had pulse oxygen saturation(SpO_(2))≤0.93 after exercise without supplementary oxygen were enrolled.Patients were divided into APP group and control group according to whether they completed the daily 12-hours APP in the first three days after enrollment.Demographic characteristics,clinical symptoms,COVID-19 vaccination status,laboratory examination,disease progression(progression to severe),time to nucleic acid negative conversion,length of hospital stay,and adverse reactions and tolerability[visual analog scale(VAS)score(the higher the score,the worse the tolerability]during APP were evaluated in two groups.Interleukin-6(IL-6),C-reactive protein(CRP),SpO_(2)/inhaled oxygen concentration(FiO_(2))ratio and ROX index(ROXI)were compared between two groups at enrollment,3rd and 7th day after enrollment.Results There were no significant differences in demographic characteristics,clinical symptoms,vaccination rates of COVID-19 and laboratory tests between the two groups.There were no statistically significant differences in IL-6,CRP,SpO_(2)/FiO_(2) ratio and ROXI between two groups at the time of enrollment.Compared with the group at the time of enrollment,SpO_(2)/FiO_(2) ratio and ROXI in APP group increased significantly at the 3rd day after enrollment[SpO_(2)/FiO_(2) ratio:461.90(457.10,466.70)vs.446.67(437.14,457.10),ROXI:25.40(23.33,25.93)vs.22.57(21.86,24.40),all P<0.05],and the levels of IL-6 and CRP in control group were significantly increased[IL-6(ng/L):18.30(6.50,37.75)vs.7.40(5.10,11.15),CR

关 键 词：清醒俯卧位 奥密克戎变异株 普通型新冠肺炎 

分 类 号：R563.1[医药卫生—呼吸系统]