摘要
目的 观察改良俯卧位通气对病毒性肺炎清醒患者的应用效果.方法 选取 2022 年 4 月—2023 年 2月病毒性肺炎清醒患者80 例,采用随机数字表法分为2 组,每组40 例,对照组采取常规俯卧位通气,观察组采取改良俯卧位通气.观察2 组康复情况、俯卧位前后血气指标[动脉血氧分压(PaO2)、动脉血二氧化碳分压(PaCO2)、血氧饱和度(SaO2)、氧合指数],血流动力学指标[心率(HR)、平均动脉压(MAP)、每搏输出量变异(SVV)、每搏输出量指数(SVI)],呼吸功能指标[气道平均压(Pmean)、气道峰压(Ppeak)、肺动态顺应性(Cydn)],血清核转录因子-κB(NF-κB)变化及压力性损伤情况.结果 观察组住院时间短于对照组(P＜0.01).俯卧位 1、2、4、8、16h时 2 组PaO2、PaCO2、SaO2、氧合指数均较俯卧位前改善,俯卧位 24、36h时 2 组Pmean、Ppeak、Cydn均较俯卧位前改善,俯卧位24、36h时血清NF-κB水平均较俯卧位前改善(P＜0.05),但2 组间比较无差异(P＞0.05);2 组组间、组内不同时点HR、MAP、SVV、SVI比较均无差异(P＞0.05);观察组压力性损伤发生率为 2.50%(1/40)低于对照组的 20.00%(8/40)(P＜0.05).结论 病毒性肺炎清醒患者行改良俯卧位通气可达到与常规俯卧位通气相近的辅助治疗效果,并可提高氧合功能、改善呼吸功能及肺顺应性、减少炎症反应和压力性损伤事件,促进疾病早期康复.
Abstract
Objective To observe the application effect of modified prone position ventilation(PPV)on conscious patients with viral pneumonia.Methods A total of 80 patients with viral pneumonia who were conscious from April 2022 to February 2023 were selected and randomly divided into two groups,with 40 cases in each group.The control group received conventional PPV,while the observation group received modified PPV.The recovery conditions,as well as the changes in blood gas indicators[arterial partial pressure of oxygen(PaO2),partial pressure of carbon dioxide(PaCO2),oxygen satura-tion(SaO2),oxygenation index]before and after prone position,hemodynamic indicators[heart rate(HR),mean arterial pressure(MAP),stroke volume variation(SVV),stroke volume index(SVI)],respiratory function indicators[mean airway pressure(Pmean),peak airway pressure(Ppeak),lung dynamic compliance(Cydn)],serum nuclear transcription factor-κB(NF-κB)changes,and pressure injury conditions of the two groups were observed.Results The length of hospitalization in the observation group was shorter than that in the control group(P＜0.01).At 1,2,4,8,and 16 h after prone position,the PaO2,PaCO2,SaO2,and oxygenation index in both groups improved compared with those before prone position.At 24 and 36 h after prone position,the Pmean,Ppeak,and Cydn in both groups improved compared with those before prone posi-tion.At 24 and 36 h after prone position,the serum NF-κB level improved compared with that before prone position(P＜0.05),but there was no difference between the two groups(P＞0.05).There was no difference in HR,MAP,SVV,and SVI between the two groups and in the same group at different time points(P＞0.05).The incidence of pressure injury in the observation group was 2.50%(1/40),which was lower than that in the control group(20.00%,8/40)(P＜0.05).Con-clusion Modified PPV in conscious patients with viral pneumonia produces similar auxiliary therapeutic effects as convention-al PPV,which can improve oxygenation,respiratory function and lung compliance,reduce inflammatory response and pressure injury events,and promote early recovery of the disease.
维普
万方数据