清醒俯卧位联合经鼻高流量湿化氧疗在轻中度呼吸衰竭的AECOPD老年病人中的应用

doi:10.3969/j.issn.1003-9198.2025.08.015

摘要/Abstract

摘要： 目的探讨清醒俯卧位联合经鼻高流量湿化氧疗(HFNC)在轻中度呼吸衰竭的慢性阻塞性肺疾病急性加重期(AECOPD)老年病人中的应用价值。方法选取2024年1—10月收治的60例轻中度呼吸衰竭的AECOPD老年病人为研究对象,随机分为观察组(n=30)和对照组(n=30),对照组仅接受HFNC,观察组予以清醒俯卧位联合HFNC。比较2组病人治疗后的排痰量、呼吸相关指标[氧合指数(PaO₂/FiO₂)、PaCO₂和改良英国医学研究委员会呼吸困难问卷(mMRC)评分]、SBP、DBP、心率(HR)以及压力性损伤发生情况。结果治疗1 d后,观察组排痰量明显多于对照组(P＜0.01)。治疗后2组PaO₂/FiO₂、PaCO₂和mMRC评分均较治疗前改善(P＜0.01),且观察组比对照组改善更明显(P＜0.05)。治疗前后2组SBP和DBP差异无统计学意义(P＞0.05),2组HR均较治疗前显著降低(P＜0.05)。观察组有2例(6.67%)发生面部压力性损伤,对照组为1例(3.33%),2组间差异无统计学意义(P＞0.05)。结论清醒俯卧位联合HFNC能有效增加轻中度呼吸衰竭的AECOPD老年病人排痰量,改善氧合指数,缓解呼吸困难,值得临床推广。

关键词: 清醒俯卧位, 经鼻高流量湿化氧疗, 慢性阻塞性肺疾病, 急性加重期

Abstract: Objective To investigate the application value of awake prone position combined with high-flow nasal cannula oxygen therapy(HFNC) in the elderly patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) presenting with mild to moderate respiratory failure. Methods A total of 60 elderly AECOPD patients with mild to moderate respiratory failure admitted to Nanjing Jiangning Hospital from January to October 2024 were enrolled in this study. All the patients were randomly divided into the observation group (n=30) and the control group (n=30). The control group was treated with HFNC, and the observation group was given awake prone position combined with HFNC. Sputum volume, oxygenation index (PaO₂/FiO₂), partial pressure of carbon dioxide (PaCO₂), modified Medical Research Council respiratory questionnaire (mMRC) score,systolic blood pressure (SBP), diastolic blood pressure (DBP), heart rate (HR) and incidence of stress injury were compared between the two groups. Results On the first day of treatment, the sputum volume in the observation group was more than that in the control group (P＜0.01). After treatment, the levels of PaO₂/FiO₂, PaCO₂ and mMRC score in both groups were significantly improved compared with those before treatment (P＜0.01), especially in the observation group (P＜0.05).The level of HR in both groups was significantly lower than that before treatment (P＜0.05). There were 2 cases (6.67%) of facial stress injury in the observation group and 1 case (3.33%) in the control group, with no statistical difference between the two groups (P＞0.05). Conclusions Awake prone position combined with HFNC can effectively enhance sputum clearance, improve oxygenation index and relieve dyspnea in the elderly AECOPD patients with mild to moderate respiratory failure, and it may be worth promoting.

Key words: awake prone position, high-flow nasal cannula oxygen therapy, chronic obstructive pulmonary disease, acute exacerbation

中图分类号:

R563.9

李小玲, 董艳, 赵明丽, 林涛, 蒋美华. 清醒俯卧位联合经鼻高流量湿化氧疗在轻中度呼吸衰竭的AECOPD老年病人中的应用[J]. 实用老年医学, 2025, 39(8): 827-831.

LI Xiaoling, DONG Yan, ZHAO Mingli, LIN Tao, JIANG Meihua. Application of awake prone position combined with nasal high-flow cannula oxygen therapy in elderly AECOPD patients with mild-to-moderate respiratory failure[J]. Practical Geriatrics, 2025, 39(8): 827-831.

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