清醒俯卧位通气在非气管插管的低氧性呼吸衰竭患者中的应用

Awake Prone Positioning for Non-intubated Patients with COVID-19-related Hypoxic Respiratory Failure

目的探讨清醒俯卧位通气对非气管插管的低氧性呼吸衰竭患者的应用效果。方法选取2022年12月至2023年1月收治的200例由新冠病毒感染导致、非气管插管的低氧性呼吸衰竭患者为研究对象,将其按随机数字表法分为对照组和研究组,每组100例,对照组予常规治疗与护理,研究组在对照组基础上予清醒俯卧位通气。比较2组干预前和干预2 h、24 h、3 d的氧合指标,血流动力学相关指标,以及干预期间不良事件发生情况。结果对照组97例、研究组98例完成本研究。干预后各时间点比较:2组氧合指数差异有统计学意义(P_(组间)<0.001),时间与分组的交互效应差异有统计学意义(P_(交互)<0.001);2组心率(P_(组间)=0.312、P_(时间)=0.125、P_(交互)=0.344)、收缩压(P_(组间)=0.835、P_(时间)=0.865、P_(交互)=0.369)和舒张压(P_(组间)=0.888、P_(时间)=0.212、P_(交互)=0.091)差异均无统计学意义;2组不良事件发生率比较差异无统计学意义(P>0.05)。结论清醒俯卧位通气安全可行,不仅能改善非气管插管的低氧性呼吸衰竭患者的肺通气功能,还能维持患者血流动力学稳定。

Objective To investigate the efficacy of awake prone positioning ventilation in non-intubated patients with hypoxic respiratory failure due to COVID-19.Methods 200 non-intubated patients with hypoxic respiratory failure due to COVID-19 admitted from December 2022 to January 2023 were selected for the study and randomly divided into the control group and the test group,100 patients in each group;the control group was given conventional treatment and care,and the test group was further given awake prone positioning ventilation;oxygenation indexes,hemodynamic indexes,and the occurrence of adverse events during the intervention period were compared between the two groups before the intervention and at 2 h,24 h,and 3 d after the intervention.Results 97 cases in the control group and 98 cases in the study group completed this study.The findings compared at different time points after the intervention showed that the difference in oxygenation indexes of the 2 groups was statistically significant(P_(intergroup)<0.001),and the difference in the _(interaction) effect of time and grouping was statistically significant(P_(interaction)<0.001);there were no statistically significant differences in heart rate(P_(intergroup)=0.312,P_(time)=0.125,P_(interaction)=0.344),systolic blood pressure(P_(intergroup)=0.835,P_(time)=0.865,P _(interaction)=0.369),and diastolic blood pressure(P_(intergroup)=0.888,P_(time)=0.212,P_(interaction)=0.091)between the 2 groups;the difference in the incidence of adverse events was not statistically significant between the 2 groups(P>0.05).Conclusions Awake prone positioning is safe and feasible in non-intubated patients with hypoxic respiratory failure caused by COVID-19,which can not only promote pulmonary ventilation but also keep hemodynamic stabilization.