经鼻高流量氧疗联合俯卧位通气在基于CURB-65的中高危社区获得性肺炎病人中的应用效果研究  

Study on the clinical efficacy of high-flow nasal cannula combined with prone position ventilation in patients with moderate-high risk community-acquired pneumonia based on CURB-65

作　　者：任梅 王梅 单南冰 罗腾达 许靖 REN Mei;WANG Mei;SHAN Nanbing;LUO Tengda;XU Jing(Department of Preventive Health Care,The Second People Hospital of Fuyang,Fuyang Anhui 236015,China;Department of Hepatology,The Second People Hospital of Fuyang,Fuyang Anhui 236015,China;Department of Critical Care Medicine,,The Second People Hospital of Fuyang,Fuyang Anhui 236015,China;Department of Raspiratory and Critical Care Medicine,The Second People Hospital of Fuyang,Fuyang Anhui 236015,China)

机构地区：[1]安徽省阜阳市第二人民医院预防保健科,安徽阜阳236015 [2]安徽省阜阳市第二人民医院肝脏病科,安徽阜阳236015 [3]安徽省阜阳市第二人民医院重症医学科,安徽阜阳236015 [4]安徽省阜阳市第二人民医院呼吸与危重症医学科,安徽阜阳236015

出　　处：《蚌埠医学院学报》2024年第8期1081-1085,共5页Journal of Bengbu Medical College

基　　金：安徽省阜阳市科研立项课题(FY2020xg01)。

摘　　要：目的:探讨经鼻高流量氧疗(HFNC)联合俯卧位通气(PPV)在基于CURB-65的中高危社区获得性肺炎病人中的应用效果。方法:纳入安徽省阜阳市第二人民医院2022年3月至2023年3月需行HFNC的240例中高危社区获得性肺炎住院病人,随机分为俯卧位组122例和对照组118例,俯卧位组予HFNC+PPV,对照组予HFNC支持,2组均接受常规护理和治疗;观察俯卧位组病人治疗前(T_(0))、俯卧位60 min(T_(1))、转为仰卧位后30 min(T_(2))呼吸频率(RR)、脉搏血氧饱和度(SpO_(2))变化情况;比较2组病人治疗第3天和第5天的吸氧浓度(FiO_(2))、氧合指数(PaO_(2)/FiO_(2))、呼吸困难评分(Borg评分)变化情况,记录2组病人住院时间、诊疗费用、此次住院期间气管插管率及发生相关不良反应情况。结果:俯卧位组病人T_(1)、T_(2)时较T_(0)时RR降低,SpO_(2)升高(P<0.05~P<0.01);治疗第3、5天俯卧位组FiO_(2)均低于同时期对照组,PaO_(2)/FiO_(2)均高于同时期对照组,Borg评分均低于同时期对照组(P<0.05~P<0.01);俯卧位组较对照组住院时间更短、住院费用更低,插管率亦明显下降(P<0.05~P<0.01);俯卧位组眼眶水肿、肩背部疼痛、腰痛发生率显著高于对照组(P<0.05)。结论:在HFNC的基础上联合PPV能改善住院CAP病人氧合指数,缩短住院时间、降低诊疗费用及插管率;病人不良反应发生率虽较高,但程度不重,经积极处理后能较快好转。Objective:To explore the clinical efficacy of high-flow nasal cannula(HFNC)combined with prone position ventilation(PPV)in patients with moderate-high risk community-acquired pneumonia(CAP)based on URB-65.Methods:A total of 240 patients with moderate-high risk CAP requiring HFNC hospitalized in the Second People′s Hospital of Fuyang City Anhui Province from March 2022 to March 2023 were enrolled,and randomly divided into the prone position group(122 cases)and control group(118 cases).The prone position group was treated with HFNC+PPV,while the control group was treated only with HFNC.The changes of pulse oxygen saturation(SpO_(2))and respiratory rate(RR)were recorded in the prone position group before treatment(T_(0)),prone position for 60 min(T_(1))and supine position for 30 min(T_(2)).The differences in the fraction of inhaled oxygen(FiO_(2)),PaO_(2)/FiO_(2)and Borg score were compared between two groups on the third and fifth day of hospitalization.The length of hospital stay,medical expenses,tracheal intubation rate and related adverse reactions were compared between two groups.Results:Compared with T_(0),the RR at T_(1)and T_(2)decreased,and the SpO_(2)at T_(1)and T_(2)increased in the prone position group(P<0.05 to P<0.01).The FiO_(2)and Borg score in the prone position group were lower than those in control group,and the PaO_(2)/FiO_(2)in the prone position group was higher than that in control group on the third and fifth day of treatment(P<0.05 to P<0.01).Compared with the control group,the length of hospital stay in the prone position group was shorter,the medical expenses and rate of tracheal intubation in the prone position group were lower(P<0.05 to P<0.01).The incidence of orbital edema,shoulder and back pain,and low back pain in the prone position group were higher than those in control group(P<0.05).Conclusions:The HFNC combined with PPV can improve the PaO_(2)/FiO_(2),reduce medical expenses,length of hospital stay and rate of intubation in moderate-high risk CAP pateints.Despite the high incid

关 键 词：社区获得性肺炎 俯卧位通气 经鼻高流量氧疗 气管插管率 

分 类 号：R473[医药卫生—护理学] R563.1[医药卫生—临床医学]