Abstract:

Objective　To observe the effect of high flow oxygen therapy in early prone position for patients with severe pneumonia related acute respiratory failure and its effect on clinical outcomes. Methods　One hundred and twenty-three patients with pneumonia related acute respiratory failure who were treated at Nanyang First People's Hospital from January 2021 to June 2022 were selected as the study objects, and were divided into a control group (61 cases) and an observation group (62 cases) according to the treatment plans they took. There were 36 males and 25 females in the control group; they were (65.25±5.47) years old. There were 38 males and 24 females in the observation group; they were (66.14±5.28) years old. The control group took routine high-flow oxygen therapy, and the observation group took high-flow oxygen therapy in early prone position. The lung ventilation function and oxygenation function 3 and 7 d after the treatment, treatment status, and clinical outcomes were compared between the two groups. χ² and t tests were used. Results　Under different treatment regimens, the percentage of forced expiratory volume in the first second (FEV1), maximal ventilatory volume (MVV), and volume of alveolar ventilation (VA) 3 d after the treatment in the observation group were higher than those in the control group [(78.25±5.33)% vs. (75.11±5.28)%, (81.44±5.25)% vs. (78.24±5.36)%, and (3.63±0.26) L/min vs. (2.77±0.24) L/min]; the FEV1, MVV, and VA 7 d after the treatment in the observation group were higher than those in the control group [(83.36±5.31)% vs. (81.35±5.28)%, (85.45±5.26)% vs. (82.49±5.18)%, and (4.03±1.21) L/min vs. (3.26±1.19) L/min]. The oxygen partial pressure (PaO₂), oxygen saturation (SaO₂), and oxygenation index (P/F) 3 d after the treatment in the observation group were higher than those in the control group [(78.82±8.64) mmHg (1 mmHg=1.333 kPa) vs. (75.11±8.33) mmHg, (94.36±5.26)% vs. (92.11±5.17)%, and (425.33±20.47) mmHg vs. (411.35±20.36) mmHg]; the PaO₂, SaO₂, and P/F 7 d after the treatment in the observation group were higher than those in the control group [(84.37±10.29) mmHg vs. (79.44±10.77) mmHg, (97.24±3.36)% vs. (95.22±3.31)%, and (492.45±40.65) mmHg vs. (471.35±40.28) mmHg]. After the treatment, the tracheal intubation rate, oxygen inhalation time, and length of ICU hospitalization in the observation group were lower than those in the control group [19.35% (12/62) vs. 32.79% (20/61), (45.33±10.36) min vs. (50.44±10.27) min, and (5.25±1.31) d vs. (6.77±1.61) d], with statistical differences (all P<0.05). After the treatment, the incidence of adverse reactions in the observation group was 11.29% (7/62), and that in the control group was 9.84% (6/61), with no statistical difference (P>0.05). The mortality rate within one month in the observation group was lower than that in the control group [3.23% (2/62) vs. 18.03% (11/61); P<0.05]. Conclusion　High flow oxygen therapy in early prone position for patients with pneumonia related acute respiratory failure can promote their recovery of ventilation and oxygenation function, and has positive significance in optimizing their diagnosis and treatment and improving their poor prognosis.

Key words:

Severe pneumonia, Acute respiratory failure, Early prone position, High flow oxygen therapy, Clinical outcomes

摘要：

目的　观察早期俯卧位下的高流量氧疗在重症肺炎相关急性呼吸衰竭患者中的应用效果及对临床结局的影响。方法　回顾性选取2021年1月至2022年6月在南阳市第一人民医院接受治疗的123例肺炎相关急性呼吸衰竭患者，根据治疗方案不同将患者分为对照组与观察组。对照组61例，男36例，女25例，年龄（65.25±5.47）岁，采用常规高流量氧疗；观察组62例，男38例，女24例，年龄（66.14±5.28）岁，取早期俯卧位配合高流量氧疗。比较两组患者治疗3、7 d后的肺通气功能、氧合功能及治疗情况、临床结局。采用χ²检验、t检验进行统计分析。结果　在不同治疗方案下，观察组治疗3 d后的第1秒用力呼气容积百分比（FEV1%）为（78.25±5.33）%、最大通气量（MVV）为（81.44±5.25）%，均高于对照组［（75.11±5.28）%、（78.24±5.36）%］，肺泡通气量（VA）为（3.63±0.26）L/min，大于对照组（2.77±0.24）L/min；治疗7 d后观察组的FEV1%为（83.36±5.31）%、MVV（85.45±5.26）%，均高于对照组［（81.35±5.28）%、（82.49±5.18）%］，VA为（4.03±1.21）L/min，大于对照组（3.26±1.19）L/min；观察组治疗3 d后的动脉血氧分压（PaO₂）为（78.82±8.64）mmHg（1 mmHg=1.333 kPa）、动脉血氧饱和度（SaO₂）为（94.36±5.26）%、氧合指数（P/F）为（425.33±20.47）mmHg，均高于对照组［（75.11±8.33）mmHg、（92.11±5.17）%、（411.35±20.36）mmHg］；治疗7 d后观察组PaO₂为（84.37±10.29）mmHg、SaO₂为（97.24±3.36）%、P/F为（492.45±40.65）mmHg，均高于对照组［（79.44±10.77）mmHg、（95.22±3.31）%、（471.35±40.28）mmHg］；治疗后，观察组气管插管率为19.35%（12/62）、吸氧时间为（45.33±10.36）min、ICU住院时长为（5.25±1.31）d，对照组分别为32.79%（20/61）、（50.44±10.27）min、（6.77±1.61）d。上述两组指标比较，差异均有统计学意义（均P<0.05）。治疗后，观察组不良反应发生率为11.29%（7/62），对照组为9.84%（6/61），两组比较差异无统计学意义（P>0.05）；观察组1个月内病死率为3.23%（2/62），低于对照组的18.03%（11/61），两组比较差异有统计学意义（P<0.05）。结论　早期取俯卧位辅助高流量氧疗可促进肺炎相关急性呼吸衰竭患者的通气功能及氧合功能恢复，对优化患者诊疗情况、改善不良预后均有积极意义。

关键词:

重症肺炎, 急性呼吸衰竭, 早期俯卧位, 高流量氧疗, 临床结局