Abstract:Objective To explore the application of different supine positions in the ventilation treatment of acute exacerbation of chronic obstructive pulmonary disease (AECOPD). Methods A total of 102 AECOPD patients who received mechanical ventilation in Nantong Third People’s Hospital of Jiangsu Province from July 2017 to June 2020 were selected. The patients were divided into control group and observation group by random number table method, with 51 cases in each group. Both groups were given routine mechanical ventilation nursing, while the control group was given conventional supine position intervention, and the observation group was given prone position ventilation position intervention. The differences between the two groups of oxygenation index (PaO2/FiO2), pH value, positive end-expiratory pressure (PEEP), dynamic lung compliance (Cdyn), and the degree of recovery were observed and compared before and after the intervention for 72 h. Results After 72 h of intervention, the PEEP and Cdyn of the two groups were higher than those before the intervention, while those of the observation group were higher than those of the control group, and the differences were statistically significant (P < 0.05). After 72 h of intervention, the PaO2/FiO2 and pH values of the observation group were higher than those before the intervention, while those of the observation group were higher than those of the control group, and the differences were statistically significant (P < 0.05). After 72 h of intervention, the acute physiology and chronic health evaluation score system score of the observation group was lower than that before the intervention, while the observation group was lower than the control group, and the differences were statistically significant (P < 0.05). Conclusion Mechanical ventilation in prone position can improve oxygenation index and blood gas analysis value, significantly improve lung compliance, and reduce the severity of the patient’s condition.
杜凤燕 张云 王东丽 陆玉梅▲. 不同卧位方式在慢性阻塞性肺疾病急性加重期通气治疗中的应用[J]. 中国医药导报, 2022, 19(29): 157-160.
DU Fengyan ZHANG Yun WANG Dongli LU Yumei▲. Application of different supine positions in ventilation therapy for acute exacerbation of chronic obstructive pulmonary disease. 中国医药导报, 2022, 19(29): 157-160.
[1] 胡莉娟,朱蕾.无创正压通气治疗慢性阻塞性肺疾病急性加重——首选的呼吸支持治疗[J].广东医学,2020,41(7):674-676.
[2] 岳伟岗,张莹,蒋由飞,等.俯卧位通气对急性呼吸窘迫综合征患者的影响[J].中国呼吸与危重监护杂志,2019, 18(6):532-536.
[3] 王玉峦,李京,张芳芳,等.不同体位对老年重症肺炎患者机械通气治疗中氧合作用的影响[J].老年医学与保健,2020,26(5):834-837.
[4] Yang YL,Xiang ZJ,Yang JH,et al. Association of β-blocker use with survival and pulmonary function in patients with chronic obstructive pulmonary and cardiovascular disease:a systematic review and meta-analysis [J]. Eur Heart J,2020,41(46):4415-4422.
[5] 中华医学会呼吸病学分会慢性阻塞性肺疾病学组.慢性阻塞性肺疾病诊治指南(2013年修订版)(二)[J].全科医学临床与教育,2013(6):603-607.
[6] 郑月月,倪朝民,吴鸣,等.早期综合肺康复干预对有创机械通气患者呼吸机相关性肺炎的预防效果观察[J].中华物理医学与康复杂志,2019,41(6):453-457.
[7] Czajka S,Zi?説bińska K,Marczenko K,et al. Validation of APACHE Ⅱ,APACHE Ⅲ and SAPS Ⅱ scores in in-hospital and one year mortality prediction in a mixed intensive care unit in Poland:a cohort study [J]. BMC Anesthesiol,2020,20(1):296.
[8] Menk M,Estenssoro E,Sahetya SK,et al. Current and evolving standards of care for patients with ARDS [J]. Intensive Care Med,2020,46(12):2157-2167.
[9] Bulpa P,Duplaquet F,Dimopoulos G,et al. Invasive Pulmonary Aspergillosis in Chronic Obstructive Pulmonary Disease Exacerbations [J]. Semin Respir Crit Care Med,2020,41(6):851-861.
[10] 谈定玉,徐艳,王云云,等.经鼻高流量氧疗在慢性阻塞性肺疾病急性加重无创正压通气间歇期应用的探索性研究[J].中华急诊医学杂志,2020,29(8):1046-1052.
[11] 王倩飞,王晨曦,梅建强,等.中医对新型冠状病毒肺炎D-二聚体升高的认识及防治[J].中华危重病急救医学,2020,32(5):622-624.
[12] 邱合信,邢疆波,李东风,等.不同体位机械通气对ARDS患者呼吸参数指标、血液流动学和胸部CT影像学的影响[J].中国CT和MRI杂志,2018,16(8):61-63,89.
[13] 安辉,程连房,李兴华,等.俯卧位通气对重度急性呼吸窘迫综合征患者心肺功能及血气指标的影响[J].中国临床医生杂志,2020,48(4):430-433.
[14] Lee HY,Cho J,Kwak N,et al. Improved Oxygenation After Prone Positioning May Be a Predictor of Survival in Patients With Acute Respiratory Distress Syndrome [J]. Crit Care Med,2020,48(12):1729-1736.
[15] 李亮,孙兆瑞,任艺,等.俯卧位通气治疗急性百草枯中毒致中重度急性呼吸窘迫综合征的临床研究[J].医学研究生学报,2019,32(1):69-72.
[16] Duan L,Wang E,Hu GH,et al. Preoperative autologous platelet pheresis reduces allogeneic platelet use and improves the postoperative PaO2/FiO2 ratio in complex aortic surgery:a retrospective analysis [J]. Interact Cardiovasc Thorac Surg,2020,31(6):820-826.
[17] 吴迪,杨凯,陈荣昌.慢性阻塞性肺疾病急性加重机械通气方式变化趋势及其疗效[J].广东医学,2020,41(7):677-682.
[18] 李长城,余旻.俯卧位通气治疗急性呼吸窘迫综合征患者疗效的Meta分析[J].海南医学,2020,31(4):529-533.
[19] 陈庆,吴亚,蒋才玉,等.APACHE-Ⅱ、PCT、ALB及CRP对慢性阻塞性肺疾病机械通气患者预后影响的临床研究[J].四川医学,2020,41(1):29-32.
[20] 王宇霞,夏欣华.体位改变对人工气道机械通气患者气囊压力的影响[J].中国实用护理杂志,2018,34(9):698-700.
[21] 文文,谢宝松.慢性阻塞性肺疾病管理中吸入装置的选择与应用[J].中华结核和呼吸杂志,2020,43(1):75-79.
[22] 王淑芳,路明惠,徐艳丽,等.ICU危重患者持续气囊压监测下机械通气压力值的研究[J].中华危重病急救医学,2020,32(10):1257-1259.
[23] 张东旭,周鹏飞.呼气末正压通气联合俯卧位通气对ARDS患者血流动力学的影响[J].安徽医学,2020,41(1):56-59.
[24] 张慧慧,胡月红,周尧英,等.俯卧位机械通气对重症肺炎呼吸衰竭并发呼吸机相关肺炎的影响[J].中华医院感染学杂志,2020,30(24):3734-3738.