摘要
目的 探讨俯卧位通气治疗神经外科重症病房相关疾病合并重症肺炎的效果及安全性,为重症肺炎的治疗提供参考。方法 回顾性分析2023年1月至2024年10月南京大学医学院附属鼓楼医院神经外科重症病房收治的41例神经外科相关疾病合并重症肺炎患者的临床资料,所有患者经常规治疗后肺部炎症无法改善并进行性加重伴严重低氧血症,予行俯卧位通气,比较患者在俯卧位治疗前,俯卧位治疗1、3、5及7 d恢复仰卧位后的血气分析[血酸碱度(pH)、动脉血氧分压(PaO_(2))、动脉血二氧化碳分压(PaCO_(2))、氧合指数]、血流动力学[心率(HR)、平均动脉压(MAP)]指标的变化情况。结果 41例患者神经外科重症病房住院天数为(20.49±5.14)d。俯卧位治疗前,俯卧位治疗1、3、5及7 d的氧合指数分别为(104.12±11.09)mmHg、(118.67±18.58)mmHg、(148.20±29.17)mmHg、(237.21±56.91)mmHg及(303.26±66.78)mmHg,呈升高趋势,差异有统计学意义(F=164.657,P<0.01);PaO_(2)分别为(79.63±4.81)mmHg、(89.90±6.83)mmHg、(106.98±12.26)mmHg、(130.40±12.03)mmHg及(135.68±13.95)mmHg,呈升高趋势,差异有统计学意义(F=219.963,P<0.01)。俯卧位通气前后PaCO_(2)、pH、HR、MAP比较差异均无统计学意义(P>0.05)。结论 俯卧位通气能够有效改善神经外科重症合并重症肺炎患者的氧合指数,随着治疗时间的延长,氧合指数逐渐改善,且对血液流动学无明显影响,对于神经外科重症病房合并重症肺炎患者安全且有效。
Objective To investigate the effectiveness and safety of prone position ventilation in treating critically ill patients with neurosurgical-related diseases complicated by severe pneumonia,and to provide reference for the treatment of severe pneumonia.Methods A retrospective analysis was conducted on the clinical data of 41 patients with neurosurgical-related diseases and severe pneumonia admitted to the Neurosurgical Intensive Care Unit of Nanjing Drum Tower Hospital,the Affiliated Hospital of Nanjing University Medical School,from January 2023 to November 2024.All patients experienced progressive worsening of pulmonary inflammation and severe hypoxemia after conventional treatment,and were given prone position ventilation.Changes in blood gas analysis[pH,arterial partial pressure of oxygen(PaO_(2)),arterial partial pressure of carbon dioxide(PaCO_(2)),oxygenation index]and hemodynamics[heart rate(HR),mean arterial pressure(MAP)]were compared before prone positioning,and at 1 day,3 days,5 days,and 7 days after resuming supine position following prone position treatment.Results The average hospitalization duration in the neurosurgical intensive care unit for the 41 patients was(20.49±5.14)days.The oxygenation index before prone positioning and at 1 day,3 days,5 days,and 7 days after pone positioning were(104.12±11.09)mmHg,(118.67±18.58)mmHg,(148.20±29.17)mmHg,(237.21±56.91)mmHg,and(303.26±66.78)mmHg,respectively,showing a significant upward trend(F=164.657,P<0.01).PaO_(2) values followed a similar pattern:(79.63±4.81)mmHg,(89.90±6.83)mmHg,(106.98±12.26)mmHg,(130.40±12.03)mmHg,and(135.68±13.95)mmHg,also demonstrating a significant increase(F=219.963,P<0.01).No statistically significant difference was observed in PaCO_(2),pH,HR and MAP before and after prone position ventilation(P>0.05).Conclusion Prone position ventilation effectively can improve the oxygenation index in critically ill neurosurgical patients with severe pneumonia.As treatment duration increases,the oxygenation index gradually improves without significant impact on hemodynamics,proving it to be both safe and effective for such patients.
作者
程龙阳
李俊
李韶雅
黎传清
徐曼曼
王嵘
赵鹏来
CHENG Longyang;LI Jun;LI Shaoya;LI Chuanqing;XU Manman;WANG Rong;ZHAO Penglai(Department of Neurosurgery,Nanjing Drum Tower Hospital,The Affiliated Hospital of Nanjing University Medical School,Nanjing,Jiangsu 210008,China)
出处
《中国临床研究》
2025年第8期1182-1186,共5页
Chinese Journal of Clinical Research
基金
北京医学奖励基金会(YXJL-2022-0351-0421)
白求恩医学科学研究基金(2022-YJ-085-J-Z-ZZ-026)
南京鼓楼医院临床研究专项资金项目(2024-LCYJ-MS-08)。
关键词
神经外科重症病房
俯卧位通气
重症肺炎
氧合指数
Neurosurgical intensive care unit
Prone position ventilation
Severe pneumonia
Oxygenation index
