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 ," /> 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 ,"/> awake prone position; high-flow nasal cannula oxygen therapy,chronic obstructive pulmonary disease,acute exacerbation ,"/> <p class="MsoNormal"> <b>清醒俯卧位</b><b>联合经鼻高流量湿化氧疗在轻中度呼吸衰竭的<span>AECOPD</span>老年病人中的应用<span></span></b>
实用老年医学

实用老年医学

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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

LI Xiaoling, DONG Yan, ZHAO Mingli, LIN Tao, JIANG Meihua   

Application of awake prone position combined with nasal high-flow nasal cannula oxygen therapy in elderly AECOPD patients with mild-to-moderate respiratory failure

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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），对照组应用HFNC，观察组予以HFNC联合清醒俯卧位。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）、动脉血二氧化碳分压(PaCO2)和改良英国医学研究委员会（mMRC）呼吸问卷评分]、血压相关指标[SBP、DBP和心率（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)；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，对照组有1例(3.33%)，2组间差异无统计意义(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')">

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 elderly acute exacerbation of chronic obstructive pulmonary disease (AECOPD) patients 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 selected as the research objects. All the patients were randomly divided into an observation group (n=30) and a control group (n=30). The control group was treated with HFNC, and the observation group was given HFNC combined with awake prone position. Sputum volume, respiratory related indexes [oxygenation index (PaO2/FiO2), partial pressure of carbon dioxide (PaCO2) and modified Medical Research Council (mMRC) respiratory questionnaire score], blood pressure related indexes [systolic blood pressure (SBP), diastolic blood pressure (DBP) and heart rate (HR)] and incidence of stress injury were compared between the two groups. Results  After treatment, the sputum output of the observation group was more than that of 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 of before treatment (P＜0.01), especially in the observation group (P＜0.05). SBP and DBP in both groups had no significant change compared with those before treatment(P＞0.05)，while HR in both groups were significantly lower than those 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 significance between the two groups (P＞0.05).Conclusion  Awake prone position combined with HFNC can effectively enhance sputum clearance, improve oxygenation index and relieve dyspnea in 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')">

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