清醒间断俯卧位联合经鼻高流量氧疗与无创呼吸机辅助通气治疗肺源性轻中度ARDS患者的对比研究  

A Comparative Study Between Awake Intermittent Prone Positioning and Nasal High-Flow Oxygen Therapy with Non-invasive Ventilation in Patients with Pulmonary ARDS of Mild to Moderate Severity

作　　者：代敏 朱瑞珍 李群锋 Dai Min;Zhu Ruizhen;Li Qunfeng(Department of Critical Care Medicine,Shaoguan Hospital of Traditional Chinese Medicine,Shaoguan 512026,China)

机构地区：[1]韶关市中医院重症医学科,广东韶关512026

出　　处：《智慧健康》2024年第35期86-90,共5页Smart Healthcare

基　　金：2023年韶关市支持科研工作者项目《清醒间断俯卧位联合经鼻高流量氧疗与无创呼吸机辅助通气对肺源性轻中度ARDS患者的对比研究》(项目编号:230330098033823)。

摘　　要：目的探究对比无创呼吸机辅助通气与清醒间断俯卧位联合经鼻高流量氧疗在肺源性轻中度急性呼吸窘迫综合征(ARDS)患者中的临床价值。方法选取2023年1月—2024年1月韶关市中医院收治的40例肺源性轻中度ARDS患者为研究对象,并根据治疗差异性进行分组对比干预,设接受常规无创呼吸机辅助通气治疗的患者为对照组,而实施清醒间断俯卧位联合经鼻高流量氧疗治疗的患者为研究组,每组20例。对比两组的血气分析指标、RR、HR、MAP指标、辅助通气治疗时间、28 d内死亡率、气管插管发生率、ICU住院天数、ICU住院总费用,以及治疗前及治疗3 d后全血白细胞计数(WBC)、中性粒细胞计数(NC)水平、血清降钙素原(PCT)水平。结果治疗前,对比两组患者的血气指标差异无统计学意义(P>0.05);治疗24 h后,两组的PaO_(2)、SaO_(2)、PaO_(2)/FiO_(2)值较治疗前升高(P<0.05),PCO_(2)值较治疗前下降(P<0.05)。治疗前,两组患者的RR、HR、MAP指标对比,差异无统计学意义(P>0.05);治疗24 h后,研究组及对照组的RR、HR、MAP指标均较治疗前下降,且研究组低于对照组(P<0.05)。对比治疗后两组的临床指标可知,研究组的辅助通气治疗时间、ICU住院天数、ICU住院总费用均低于对照组(P<0.05);两组患者28 d内死亡率、气管插管发生率比较,差异均无统计学意义(P>0.05)。与治疗前对比,两组患者治疗3 d后WBC、NC、PCT水平均显著降低,且研究组低于对照组(P<0.05)。结论采用清醒间断俯卧位联合经鼻高流量氧疗有利于改善肺源性轻中度ARDS患者的血气分析和临床相关指标,从而使得患者的通气情况和炎性因子水平得到有效缓解,有利于促进患者的病情恢复,在临床中具有积极的意义。Objective To explore and compare the clinical value of non-invasive ventilator assisted ventilation and awake intermittent prone position combined with nasal high flow oxygen therapy in patients with pulmonary mild to moderate acute respiratory distress syndrome(ARDS).Methods A total of 40 patients with pulmonary mild to moderate ARDS treated in Shaoguan Hospital of Traditional Chinese Medicine from January 2023 to January 2024 were selected as the study objects,and grouped and compared according to treatment differences.The patients receiving routine non-invasive ventilator assisted ventilation treatment were set as the control group.The study group included 20 patients in each group who were treated with awake intermittent prone position combined with nasal high-flow oxygen therapy.Blood gas analysis indexes,RR,HR,MAP indexes,duration of assisted ventilation,mortality within 28 days,incidence of tracheal intubation,length of stay in ICU,total hospitalization cost in ICU,whole blood white blood cell count(WBC),neutrophil count(NC)level and serum procalcitonin(PCT)level before and after treatment were compared between the two groups.Results Before treatment,there was no significant difference in blood gas indexes between the two groups(P>0.05).After 24 h of treatment,the PaO_(2),SaO_(2)and PaO_(2)/FiO_(2)values of the two groups were higher than those before treatment(P<0.05),while the PCO_(2)values were lower than those before treatment(P<0.05).Before treatment,there was no significant difference in RR,HR and MAP indexes between the two groups(P>0.05).After 24 h of treatment,RR,HR and MAP indexes in the study group and the control group were lower than those before treatment(P<0.05).Comparing the clinical indexes of the two groups after treatment,it can be seen that the treatment time of auxiliary ventilation,ICU stay days and total hospitalization cost of ICU in the study group were lower than those in the control group(P<0.05).There was no significant difference in mortality and incidence of tracheal intubatio

关 键 词：清醒间断俯卧位 经鼻高流量氧疗 无创呼吸机辅助通气 肺源性轻中度ARDS 

分 类 号：R47[医药卫生—护理学]