俯卧位通气对新型冠状病毒肺炎患者肺功能的改善作用  

Improvement of lung function through prone position ventilation for patients with COVID‑19

作　　者：柳舟[1] 程利 张亮[3] 柏文辉 周建林[5] 王璐[1] 詹丽英[1] 徐伟[6] 峁勇 倪达 LIU Zhou;CHENG Li;ZHANG Liang;BAI Wenhui;ZHOU Jianlin;WANG Lu;ZHAN Liying;XU Wei;MAO Yong;NI Da(Dept.of Critical Care Medicine,Renmin Hospital of Wuhan University,Wuhan 430060,Hubei,China;Dept.of Critical Care Medicine,Eastern Campus,Renmin Hospital of Wuhan University,Wuhan 430060,Hubei,China;Dept.of Radiology,Renmin Hospital of Wuhan University,Wuhan 430060,Hubei,China;Dept.of Hepatological,Eastern Campus,Renmin Hospital of Wuhan University,Wuhan 430060,Hubei,China;Dept.of Orthopedics,Renmin Hospital of Wuhan University,Wuhan 430060,Hubei,China;Dept.of Critical Care Medicine,Shanghai Ninth People's Hospital of Shanghai JiaoTong University School of Medicine,Shanghai 200011,China;Dept.of Thoracic Surgery,Shanghai Ninth People's Hospital of Shanghai JiaoTong University School of Medicine,Shanghai 200011,China)

机构地区：[1]武汉大学人民医院重症医学科,湖北武汉430060 [2]武汉大学人民医院东院重症医学科,湖北武汉430200 [3]武汉大学人民医院放射科,湖北武汉430060 [4]武汉大学人民医院骨科,湖北武汉430060 [5]武汉大学人民医院东院肝胆外科,湖北武汉430200 [6]上海交通大学医学院附属第九人民医院重症医学科,上海200011 [7]上海交通大学医学院附属第九人民医院胸外科,上海200011

出　　处：《武汉大学学报（医学版）》2023年第9期1046-1052,共7页Medical Journal of Wuhan University

基　　金：国家重点研发计划项目(编号:2021YFC2501800)。

摘　　要：目的:研究俯卧位通气对新型冠状病毒肺炎(新冠肺炎)患者肺功能改善的效果。方法:回顾性分析2022年4月20日至5月20日上海交通大学医学院附属第九人民医院收治的45例新冠肺炎患者。根据患者的意识状态及体位,随机分为插管俯卧位组(n=15)、清醒俯卧位组(n=15)及仰卧位组(n=15),分别记录实验室检查结果。结果:患者的年龄、性别、身高、体重、临床表现、基础疾病等组间差异无显著统计学意义(均P>0.05)。清醒俯卧位组较插管俯卧位组患者的心率慢且氧饱和度高(均P<0.05),实验室检查及影像学未见明显差异(均P>0.05)。清醒俯卧位组较仰卧位组患者氧分压及氧合指数更高,二氧化碳分压及乳酸值更低(均P<0.05)。清醒俯卧位组与插管仰卧位组患者的并发症发生率无统计学意义(均P>0.05)。结论:插管俯卧位及清醒俯卧位均可一定程度上改善新冠肺炎患者的肺功能,早期实施理论上可降低插管率、呼吸机相关肺炎发生率及病死率。Objective:To summarize and discuss the effect of prone position ventilation(PPV)on lung func⁃tion for COVID⁃19 patients.Methods:We retrospectively analyzed 45 COVID⁃19 patients admitted to Shanghai Ninth People's Hospital of Shanghai JiaoTong University School of Medicine from April 20th to May 20th,2022.The patients were randomly divided into intubated PPV group(n=15),awake PPV group(n=15),and supine group(n=15)according to the state of consciousness and posi⁃tion,and the examination results were compared.Results:There was no significant difference in age,gender,height,weight,clinical features,and previous diseases between groups(all P>0.05).When compared with intubated PPV group,the awake PPV group had slower HR and higher SpO2(all P<0.05),without differences in laboratory and imageological examinations(all P>0.05).When com⁃pared with the supine position group,awake PPV group had higher PaO2 and P/F,as well as lower PaCO2 and serum lactate level.There was no significant difference in complications between awake and intubated PPV group(all P>0.05).Conclusion:Both intubation prone position and awake prone position could improve the lung function of COVID⁃19 patients to a certain extent.Early implementa⁃tion of PPV theoretically reduces intubation rate,the incidence of ventilator⁃associated pneumonia and mortality of COVID⁃19.

关 键 词：俯卧位通气 仰卧位 新型冠状病毒肺炎 肺功能 疗效 

分 类 号：R563[医药卫生—呼吸系统]