俯卧位通气时长对重症肺炎病人氧合及肠内营养耐受性的影响

Effect of prone position ventilation duration on oxygenation and enteral nutrition tolerance in patients with severe pneumonia

目的:探讨俯卧位通气持续时长对重症肺炎病人早期氧合及肠内营养安全性和有效性的影响。方法:选取2022年4月—2023年8月在广东省某三级甲等医院重症医学科监护室住院的90例重症肺炎病人,根据俯卧位通气时长分为6~<12 h组(T1组)30例,12~<16 h组(T2组)30例,≥16 h组(T3组)30例,比较3组病人俯卧位后5 d内的氧合指数、胃残余量、肠内营养相关并发症发生情况以及白蛋白和前白蛋白值的变化。结果:3组病人氧合状况均得到改善,通气第4天和第5天T2组和T3组改善效果优于T1组(P<0.05);T1组和T2组中断和反流并发症发生率较低,且白蛋白和前白蛋白较通气前改善(P<0.05)。结论:重症肺炎病人俯卧位通气持续时长为12~<16 h时,既可以有效改善病人氧合状况和营养状况,且并发症发生率较低。

Objective:To investigate the effect of the duration of prone position ventilation on the safety and effectiveness of early oxygenation and enteral nutrition in patients with severe pneumonia.Methods:90 patients with severe pneumonia who were hospitalised in the intensive care unit of a tertiary hospital in Guangdong province from April 2022 to August 2023 were selected and divided into the 6~<12 h group(T1 group,n=30),the 12~<16 h group(T2 group,n=30),and the≥16 h group(T3 group,n=30)according to the length of prone position ventilation.We observed and compared the oxygenation index,gastric residual volume and the occurrence of enteral nutrition⁃related complications,as well as the index changes of albumin and prealbumin in the three groups within 5 d after prone position.Results:The oxygenation status of all three groups of patients improved,and on the 4th and 5th day of ventilation,the improvement effect of T2 and T3 groups was better than that of T1 group(P<0.05).The incidence of interruption and reflux complications was low in T1 and T2 groups,and albumin and prealbumin improved compared to before ventilation(P<0.05)..Conclusion:When the duration of prone ventilation in patients with severe pneumonia is 12~<16 h,it can effectively improve the oxygenation status and nutritional status of the patients with a lower complication rate.