摘要
目的:探究改良俯卧位联合经鼻高流量湿化氧疗(HFNC)在脓毒症机械通气患者序贯脱机治疗中的临床应用效果。方法:选取2022年9月—2024年9月廉江市人民医院收治的200例确诊脓毒症且经过有创机械通气治疗、撤离呼吸机的患者作为研究对象,按随机数字表法分为观察组(n=100)和对照组(n=100)。对照组患者采用HFNC进行治疗,观察组患者在此基础上采用改良俯卧位联合HFNC进行治疗。比较两组呼吸功能指标(RR、HR、MAP)、动脉血气指标(PaO_(2)、PaCO_(2)、氧合指数、血乳酸)、治疗48 h内气管重插率、28 d死亡率、总住院时间及并发症。结果:治疗24 h后,两组RR、HR明显降低,MAP升高,观察组RR、HR低于对照组,MAP高于对照组(P<0.05);治疗24 h后,两组PaO_(2)、氧合指数明显高于治疗前,PaCO_(2)、血乳酸明显低于治疗前,观察组PaO_(2)、氧合指数明显高于对照组,PaCO_(2)、血乳酸明显低于对照组(P<0.05);观察组总住院时间短于对照组(P<0.05);观察组并发症发生率低于对照组(P<0.05)。结论:改良俯卧位联合HFNC对脓毒症机械通气患者序贯脱机治疗具有积极影响,在治疗实践中展现出较好的疗效与安全性,有助于改善患者氧合状况,降低再插管率和并发症发生率。
Objective:To explore the clinical application of modified prone positioning combined with highflow nasal cannula oxygen therapy(HFNC)in sequential weaning treatment of sepsis patients undergoing mechanical ventilation.Method:A total of 200 patients diagnosed with sepsis and treated with invasive mechanical ventilation who were weaned from the ventilator and admitted to Lianjiang People's Hospital from September 2022 to September 2024 were selected as the research objects and divided into the observation group(n=100)and the control group(n=100)using the random number table method.Patients in the control group were treated with HFNC,while those in the observation group received modified prone position combined with HFNC on this basis.Respiratory function indexes(RR,HR,MAP),arterial blood gas indexes(PaO_(2),PaCO_(2),oxygenation index,blood lactate),tracheal reintubation rate within 48 hours of treatment,28-day mortality,total hospital stay and complications were compared between the two groups.Result:After 24 hours of treatment,RR,HR decreased significantly and MAP increased in both groups,RR and HR in the observation group were lower than those in the control group,and MAP was higher than that in the control group(P<0.05).After 24 hours of treatment,PaO_(2) and oxygenation index in both groups were significantly higher than those before treatment,the PaCO_(2) and blood lactate were significantly lower than those before treatment,and PaO_(2) and oxygenation index in the observation group were significantly higher than those in the control group,PaCO_(2) and blood lactate were significantly lower than those in the control group(P<0.05).The total hospital stay was shorter than that in the control group(P<0.05).The incidence of complications in the observation group was lower than that in the control group(P<0.05).Conclusion:The modified prone position combined with HFNC has a positive impact on sequential weaning treatment of sepsis patients undergoing mechanical ventilation,demonstrating good efficacy and safety in clinical practice,which is helpful to improve the oxygenation status of patients,reduce the re-intubation rate and the incidence of complications.
作者
胡巧
彭玉兰
李婷
HU Qiao;PENG Yulan;LI Ting(Department of Critical Care Medicine,Lianjiang People's Hospital,Lianjiang 524400,China;不详)
出处
《中国医学创新》
2025年第22期111-115,共5页
Medical Innovation of China
基金
湛江市科技计划项目(2024B01374)。
关键词
高流量湿化氧疗
脓毒症
改良俯卧位
有创机械通气
High-flow nasal cannula oxygen therapy
Sepsis
Modified prone position
Invasive mechanical ventilation
