仰俯卧位机械通气对重症肺炎合并呼吸衰竭患者肺功能及炎症因子水平的影响

Effects of Prone and Supine Mechanical Ventilation on Pulmonary Function and Inflammatory Cytokine Levels in Patients with Severe Pneumonia Complicated by Respiratory Failure

【目的】探讨仰俯卧位机械通气对重症肺炎合并呼吸衰竭患者肺功能及炎症因子水平的影响。【方法】选择2020年1月至2022年1月在中国人民解放军空军第九八六医院诊治的80例重症肺炎合并呼吸衰竭患者,随机抽签法分为观察组和对照组,每组40例。观察组采用俯卧位进行机械通气,对照组采用常规仰卧位进行机械通气。比较两组临床疗效、不良事件发生率及治疗前后肺功能指标[第1秒用力呼气容积(FEV_(1))、呼气流量峰值(PEF)、第1秒用力呼气容积占用力肺活量的比值(FEV_(1)/FVC)以及动态肺顺应性(Cydn)]、炎症因子[可溶性髓样细胞触发受体1(sTREM-1)、超敏C反应蛋白(hs-CRP)、白细胞介素-6(IL-6)]水平、血气指标[血氧饱和度(SpO_(2))、动脉血氧分压(PaO_(2))和血二氧化碳分压(PaCO_(2))]。【结果】观察组总有效率显著高于对照组(P<0.05);治疗后,两组FEV_(1)、PEF、FEV_(1)/FVC、Cdyn均高于治疗前(P<0.05),且观察组FEV_(1)、PEF、FEV_(1)/FVC、Cdyn均高于对照组(P<0.05);治疗后,两组sTREM-1、hs-CRP、IL-6均低于治疗前(P<0.05),且观察组sTREM-1、hs-CRP、IL-6低于对照组(P<0.05);治疗后,两组PaO_(2)、SpO_(2)高于治疗前,PaCO_(2)低于治疗前(P<0.05),且观察组PaO_(2)、SpO_(2)高于对照组,PaCO_(2)低于对照组(P<0.05);两组不良事件发生率比较,差异无统计学意义(P>0.05)。【结论】俯卧位机械通气治疗重症肺炎合并呼吸衰竭患者的疗效优于仰卧位,更利于改善患者肺功能,调节炎症因子水平与血气指标,且安全性较好,推荐临床应用。

【Objective】To investigate the effects of prone and supine mechanical ventilation on pulmonary function and levels of inflammatory cytokines in patients with severe pneumonia complicated by respiratory failure.【Methods】Eighty patients with severe pneumonia complicated by respiratory failure treated in our hospital from January 2020 to January 2022 were selected.They were randomly divided into the observation group and the control group,with 40 cases in each group.Patients in the observation group received mechanical ventilation in the prone position,while the control group was ventilated in the standard supine position.Clinical efficacy,adverse event rates,and pulmonary function parameters[Forced Expiratory Volume in 1 second(FEV_(1)),Peak Expiratory Flow(PEF),ratio of FEV_(1) to Forced Vital Capacity(FEV_(1)/FVC),and Dynamic Lung Compliance(Cdyn)],levels of inflammatory cytokines[Soluble Triggering Receptor Expressed on Myeloid cells-1(sTREM-1),High Sensitivity C-reactive Protein(hs-CRP),Interleukin-6(IL-6)],and blood gas indicators[Oxygen Saturation(SpO_(2)),Arterial Oxygen Partial Pressure(PaO_(2)),and Carbon Dioxide Partial Pressure(PaCO_(2))]were compared between the two groups.【Results】The overall effectiveness in the observation group was significantly higher than that in the control group(P<0.05).Post-treatment FEV_(1),PEF,FEV_(1)/FVC,and Cdyn in both groups were higher than those before treatment(P<0.05),with FEV_(1),PEF,FEV_(1)/FVC,and Cdyn in the observation group being significantly higher than those the control group(P<0.05).Post-treatment sTREM-1,hs-CRP,and IL-6 in both groups were lower than those before treatment(P<0.05),and sTREM-1,hs-CRP,and IL-6 in the observation group were significantly lower than those in the control group(P<0.05).After treatment,PaO_(2) and SpO_(2) in both groups were higher than before treatment,and PaCO_(2) was lower than before treatment(P<0.05);And the PaO_(2) and SpO_(2) in the observation group showed higher than those in the control group,while PaCO_(2) showed lower than those in the control group(P<0.05).The incidence of adverse events between the two groups were not significantly different(P>0.05).【Conclusion】Prone position mechanical ventilation offers better treatment efficacy for patients with severe pneumonia and respiratory failure in comparison to the supine ventilation,through favorably improving pulmonary function,modulating inflammatory cytokine levels,and blood gas indicators.It also demonstrates good safety,thus recommended for clinical application.