不同头高足低俯卧位通气角度对重型新型冠状病毒感染患者血流动力学和氧合指标的影响  

Influence of Different Ventilation Angles of Head High Foot Low Prone Position on Hemodynamics and Oxygenation Indexes in Patients with Severe Corona Virus Disease 2019

作　　者：赵丽丽[1] 朱金霞[1] 王慧敏[1] 王鑫[1] ZHAO Lili;ZHU Jinxia;WANG Huimin;WANG Xin(Intensive Care Unit of Surgery,the First Affiliated Hospital of Zhengzhou University,Zhengzhou 450000,China)

机构地区：[1]郑州大学第一附属医院外科重症监护病区,河南郑州450000

出　　处：《河南医学研究》2023年第19期3496-3499,共4页Henan Medical Research

摘　　要：目的探讨不同头高足低俯卧位通气角度对重型新型冠状病毒感染(COVID-19)患者血流动力学和氧合指标的影响。方法选择2022年1—12月郑州大学第一附属医院收治的162例重型COVID-19患者,采用随机数字表法将患者分为0~5°组(38例)、10°组(40例)、30°组(43例)及45°组(41例)。利用电动病床调节床面倾斜角度实施头高足低俯卧位通气。通气后6 h和12 h,比较各组患者平均动脉压(MAP)、心率(HR)、中心静脉压(CVP)、动脉血氧分压(PaO_(2))和二氧化碳分压(PaCO_(2))以及氧合指数(PaO_(2)/FiO_(2))。结果俯卧位后6 h,各组MAP、HR及CVP比较,差异无统计学意义(P>0.05);俯卧位后12 h,各组MAP和CVP比较,差异无统计学意义(P>0.05),30°组和45°组HR低于0~5°组和10°组(P<0.05)。俯卧位后6 h和12 h,各组PaO_(2)、PaCO_(2)及PaO_(2)/FiO_(2)比较,差异有统计学意义(P<0.05),且30°组、45°组PaCO_(2)低于0~5°组和10°组,PaO_(2)/FiO_(2)高于0~5°组和10°组(P<0.05);30°组、45°组PaO_(2)高于0~5°组(P<0.05);30°组和45°组各指标比较,差异无统计学意义(P>0.05)。结论30°、45°头高足低俯卧位通气能较好地改善重型COVID-19患者的氧合状态,效果较0~5°或10°头高足低俯卧位更明显,但对血流动力学的改善不明显。Objective To explore the influence of different ventilation angles of head high foot low prone position on hemodynamics and oxygenation indexes in patients with severe corona virus disease 2019(COVID-19).Methods A total of 162 severe COVID-19 patients treated in the First Affiliated Hospital of Zhengzhou University from January to December 2022 were selected,and they were divided into 0-5°group(38 cases),10°group(40 cases),30°group(43 cases)and 45°group(41 cases)by random number table method.The electric bed was used to adjust the bed surface tilt angle to implement head high foot low prone position ventilation,and the mean arterial pressure(MAP),heart rate(HR),central venous pressure(CVP),partial oxygen pressure(PaO_(2)),partial carbon dioxide pressure(PaCO_(2))and oxygenation index(PaO_(2)/FiO_(2))were compared among different groups at 6 hours and 12 hours after ventilation.Results After prone position for 6 hours,there were no statistical differences in MAP,HR and CVP among all groups(P>0.05).After prone position for 12 hours,there were no statistically significant differences in MAP and CVP among all groups(P>0.05),the HR in 30°and 45°groups were lower than those in 0-5°and 10°groups(P<0.05).After prone position for 6 hours and 12 hours,the PaO_(2),PaCO_(2)and PaO_(2)/FiO_(2)were statistically different among all groups(P<0.05),and the PaCO_(2)in 30°and 45°groups were lower than those in 0-5°and 10°groups,while PaO_(2)/FiO_(2)were higher than that in 0-5°and 10°groups(P<0.05).The PaO_(2)in 30°and 45°groups were higher than those in 0-5°groups(P<0.05).There was no statistical difference in all index between 30°group and 45°group(P>0.05).Conclusion Ventilation at 30°and 45°can better improve the oxygenation status in patients with severe COVID-19,and the effect is more obvious than that at 0-5°or 10°prone position,but the improvement of hemodynamics is not obvious.

关 键 词：新型冠状病毒感染 机械通气 俯卧位 血流动力学 氧合指标 

分 类 号：R563.1[医药卫生—呼吸系统]