高流量氧疗联合俯卧位治疗4例重型新型冠状病毒肺炎患者的经验总结

Experience of high-flow nasal cannula oxygen therapy combined with prone position in treatment of 4 severe cases of corona virus disease 2019

总结2020年1月23日至2月16日皖南医学院弋矶山医院收治的4例重型新型冠状病毒肺炎(简称新冠肺炎)患者的救治经验.4例患者入院时静息状态下脉搏血氧饱和度(SpO2)均≤0.93.所有患者除常规抗病毒对症支持治疗外,均同时给予高流量氧疗(HFNC)及间断俯卧位的综合治疗策略.俯卧位1h后SpO2较初始仰位明显改善(0.935±0.040比0.880±0.022,P<0.05).与治疗前比较,4例患者治疗后1d起SpO2、动脉血氧分压(PaO2)、氧合指数(PaO2/FiO2)均明显升高〔SpO2:0.965±0.013比0.880±0.022,PaO2(mmHg,1mmHg≈0.133kPa):86.75±10.24比63.50±3.87,PaO2/FiO2(mmHg):182.00±16.41比125.00±12.49,均P<0.05〕,心率、平均动脉压(MAP)、呼吸频率、pH值及血乳酸(Lac)差异无统计学意义.4例患者均成功救治,1例好转出院,住院11d,余3例均明显好转.总结4例患者的救治情况表明早期HFNC联合俯卧位可显著改善重型新冠肺炎患者的氧合功能,有助于患者渡过重症期病程,避免行有创机械通气,给临床诊疗提供参考.

To summarize the treatment experience of 4 severe patients with corona virus disease 2019(COVID-19)admitted to Yijishan Hospital of Wannan Medical College in January 23rd to February 16th,2020.The resting pulse oxygen saturation(SpO2)of 4 cases was less than 0.93.All patients were given high-flow nasal cannula oxygen therapy(HFNC)and intermittent prone position in addition to conventional antiviral and supportive treatment.The SpO2 was improved obviously after 1 hour in prone position compared with supine position(0.935±0.040 vs.0.880±0.022,P<0.05).The SpO2,arterial partial pressure of oxygen(PaO2)and oxygenation index(PaO2/FiO2)after 1 day of treatment were significantly increased compared with those before treatment[SpO2:0.965±0.013 vs.0.880±0.022,PaO2(mmHg,1 mmHg≈0.133 kPa):86.75±10.24 vs.63.50±3.87,PaO2/FiO2(mmHg):182.00±16.41 vs.125.00±12.49,all P<0.05],and heart rate,blood pressure(MAP),respiratory rate,pH value and blood lactic acid(Lac)had no significant differences.Four patients were treated successfully,1 case was discharged after improvement,the length of hospital stay was 11 days,and other 3 cases were significantly improved.The treatment of four patients showed that the early HFNC combined with prone position can significantly improve the oxygen function of severe COVID-19 patients,benefit patients through the severe stage of illness,and partly avoid the invasive mechanical ventilation,which provided the reference for clinical treatment.