俯卧位通气对重症新型冠状病毒肺炎并呼吸困难患者氧合水平的影响

Effect of prone ventilation on oxygenation level in patients with severe coronavirus disease 2019 combined with dyspnea

  • 摘要: 目的 探讨俯卧位通气对重症新型冠状病毒肺炎并呼吸困难患者氧合水平的影响。方法 选取武汉火神山医院2020年2月9日-3月16日收治的重症新型冠状病毒肺炎并发呼吸困难的患者,按照治疗时所采取的体位差异进行1∶1配对,对照组仰卧位进行治疗,实验组俯卧位下进行相同治疗,对比两组不同时段通气参数及部分生理指标的变化。结果 共纳入患者52例,每组26例。对照组男性12例,女性14例,平均年龄为(45.23±6.5)岁;实验组男性15例,女性11例,平均年龄为(52.14±5.2)岁;两组患者年龄、性别差异无统计学意义(P>0.05)。实验组治疗前、治疗后1 h、6 h、12 h氧分压逐渐上升,分别为78.6%±6.1%、97.7%±6.0%、102.7%±7.1%、111.3%±7.4%,对照组分别为79.3%±5.2%、83.9%±4.6%、89.5%±5.7%、84.9%±5.2%。实验组治疗前、治疗后1 h、6 h、12 h氧合指数为123.9±2.6、166.1±8.2、186.6±7.9、193.1±8.2,对照组分别为121.1±6.8、135.0±7.6、146.3±7.5、141.9±7.4。实验组治疗前、治疗后1 h、6 h、12 h脉搏血氧饱和度为88.4%±4.9%、97.4%±6.9%、97.9%±8.0%、98.1%±7.3%,对照组分别为87.9%±4.1%、94.1%±6.0%、93.1%±6.4%、94.5%±6.2%。实验组在治疗后1 h、6 h、12 h时的氧分压、氧合指数、脉搏血氧饱和度均显著优于对照组(P<0.05)。治疗后1 h、6 h、12 h时的心率、平均动脉压以及中心静脉压两组间差异无统计学意义(P>0.05);对照组死亡7例,实验组死亡9例,两组死亡率差异无统计学意义(P=0.548)。结论 采取俯卧位进行通气可有效地改善重症患者的氧合水平,不会增加患者心脏负担,但不能降低此类患者死亡率。

     

    Abstract: Objective To investigate the effect of prone ventilation on the oxygenation level of patients with severe coronavirus disease 2019 (COVID-19) and dyspnea. Methods Patients with severe COVID-19 complicated dyspnea admitted to Wuhan Huoshenshan Hospital from February 9,2020 to March 16,2020,were selected as research subjects.According to the posture taken during treatment,1:1 pairing was carried out.Patients in the control group were treated in the supine position,and patients in the experimental group were treated in the prone position.The changes in ventilation parameters and some physiological indicators of the two groups at different time points were compared. Results Of the 52 patients enrolled in our study,there were 12 males and 14 females in the control group,with an average age of 45.23±6.5 years,and 15 males and 11 females in the experimental group,with an average age of 52.14±5.2 years;there was no significant difference in age and sex between the two groups.Before treatment,at 1 h,6 h and 12 h,the oxygen partial pressure in the experimental group was 78.6%±6.1%,97.7%±6.0%,102.7%±7.1%,111.3%±7.4%,while that in the control group was 79.3%±5.2%,83.9%±4.6%,89.5%±5.7%,84.9%±5.2%,respectively;the oxygenation index of the experimental group was 123.9±2.6,166.1±8.2,186.6±7.9,193.1±8.2,while that of the control group was 121.1±6.8,135.0±7.6,146.3±7.5,141.9±7.4;the pulse oxygen saturation of the experimental group was 88.4%±4.9%,97.4%±6.9%,97.9%±8.0%,98.1%±7.3%,while that of the control group was 87.9%±4.1%,94.1%±6.0%,93.1%±6.4%,94.5%±6.2%;after treatment,the oxygen partial pressure,oxygenation index and pulse oxygen saturation of the experimental group were superior to those of the control group (all P<0.05).There was no statistically significant difference in heart rate,mean arterial pressure,and central venous pressure at 1 h,6 h,and 12 h (all P>0.05).There were 7 deaths in the control group,and 9 deaths in the experimental group,without statistically significant difference in mortality between the two groups (P>0.05). Conclusion Adopting a prone position for ventilation can effectively improve the oxygenation level of critically ill patients,without increasing the cardiac burden of patients,but it has little significance in reducing the mortality of such patients.

     

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