改良俯卧位通气对清醒病毒性肺炎患者呼吸循环、康复指标及并发症的影响  

Effect of Modified Prone Position Ventilation on Respiratory Circulation,Rehabilitation Indicators,and Complications in Conscious Patients with Viral Pneumonia

作　　者：姚娜 柳娟娟 张婷婷 YAO Na;LIU Juanjuan;ZHANG Tingting(The First Department of Respiratory and Critical Care Medicine,Zhangjiakou First Hospital,Zhangjiakou,Hebei 075000,China)

机构地区：[1]张家口市第一医院呼吸与危重症医学一科,河北张家口075000

出　　处：《临床误诊误治》2024年第6期24-29,共6页Clinical Misdiagnosis & Mistherapy

基　　金：张家口市重点研发计划项目(2322043D)。

摘　　要：目的探讨改良俯卧位通气对清醒病毒性肺炎患者呼吸循环、康复指标、并发症的影响。方法选取2021年8月—2023年6年就诊的134例病毒性肺炎,按照随机数字表法分为研究组、对照组,各67例,对照组采用常规俯卧位通气,研究组采用改良俯卧位通气。比较2组康复指标、血气指标[氧合指数(PaO_(2)/FiO_(2))、动脉血二氧化碳分压(PaCO_(2))、动脉血氧分压(PaO_(2))、血氧饱和度(SpO_(2))]、血流动力学指标[心率(HR)、中心静脉压(CVP)、平均动脉压(MAP)]、呼吸功能指标[平台压(Pplat)、气道峰压(Ppeak)、平均气道压(Pmean)]、炎症指标[白细胞介素-6(IL-6)、粒细胞-巨噬细胞集落刺激因子(GM-CSF)、肿瘤坏死因子-α(TNF-α)]、并发症及压力性损伤发生率。结果研究组住院时间短于对照组(P<0.05);2组俯卧2、4、8、12、16 h PaCO_(2)、PaO_(2)、PaO_(2)/FiO_(2)、SpO_(2),以及俯卧24、36 h时Ppeak、Pmean、Pplat、GM-CSF、IL-6、TNF-α均较俯卧前得以明显改善(P<0.05),但2组间比较差异无统计学意义(P>0.05);2组组间、组内不同时间点CVP、MAP、HR比较,差异无统计学意义(P>0.05);研究组并发症总发生率2.99%(2/67)低于对照组11.94%(8/67),压力性损伤发生率2.99%(2/67)低于对照组13.43%(9/67)(P<0.05)。结论在清醒病毒性肺炎患者中,改良俯卧位通气可达到与常规俯卧位通气相近的辅助治疗效果,能改善机体氧合功能、呼吸循环功能,降低并发症及压力性损伤发生风险,加速病情康复。Objective To investigate the effects of modified prone position ventilation(PPV)on respiratory circulation,rehabilitation indicators,and complications in conscious patients with viral pneumonia(VP).Methods In total,134 VP patients treated from August 2021 to June 2023 were selected and divided into research group(n=67)and control group(n=67)according to the random number table method.The control group received conventional PPV,while the research group received modified PPV.The rehabilitation indicators,blood gas indicators[oxygenation index ratio of arterial partial pressure(PaO_(2))of oxygen to fractional inspired oxygen(PaO_(2)/FiO_(2)),arterial partial pressure of carbon dioxide(PaCO_(2)),blood oxygen saturation(SpO_(2))],hemodynamic indicators[heart rate(HR),central venous pressure(CVP),mean arterial pressure(MAP)],respiratory function indicators[plateau pressure(Pplat),airway peak pressure(Ppeak),mean airway pressure(Pmean)],inflammatory indicators[interleukin-6(IL-6),granulocyte-macrophage colony stimulating factor(GM-CSF),tumor necrosis factor-α(TNF-α)],complications,and incidence of pressure injury were compared between the two groups.Results The length of hospitalization was shorter in the research group than in the control group(P<0.05).The PaCO_(2),PaO_(2),PaO_(2)/FiO_(2),SpO_(2) at 2,4,8,12,and 16 h in prone position,as well as Ppeak,Pmean,Pplat,GM-CSF,IL-6,and TNF-αat 24 and 36 h in prone position,were significantly improved compared with those before prone position in both groups(P<0.05),which,however,showed no significant difference(P>0.05).There was no significant intergroup and intragroup difference in CVP,MAP,and HR at different time points(P>0.05).The total incidence of complications was lower in research group than in control group[2.99%(2/67)vs.(11.94%(8/67))],and the incidence of pressure injury was lower than that of control group[2.99%(2/67)vs.(13.43%(9/67))](P<0.05).Conclusion In conscious patients with VP,modified PPV can achieve similar auxiliary therapeutic effects as conventional P

关 键 词：肺炎 病毒性 改良俯卧位通气 血气分析 血流动力学 白细胞介素-6 肿瘤坏死因子-α 平均气道压 并发症 

分 类 号：R563.1[医药卫生—呼吸系统]