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中华重症医学电子杂志 ›› 2022, Vol. 08 ›› Issue (01): 85 -89. doi: 10.3877/cma.j.issn.2096-1537.2022.01.013

病例报告 上一篇    下一篇

早期清醒俯卧位联合经鼻高流量氧疗治疗重型新型冠状病毒肺炎一例
鲁卫华 1 , ( ), 王涛 1, 秦雪梅 1, 徐前程 1, 姜小敢 1   
  1. 1. 241000 安徽芜湖,皖南医学院弋矶山医院重症医学科
  • 收稿日期:2021-02-23 出版日期:2022-02-28
  • 通信作者: 鲁卫华
  • 基金资助:
    安徽省中央引导地方科技发展专项项目(201907d07050001); 皖南医学院弋矶山医院“高峰”培育计划(GF2019J03)

Early waking prone position combined with HFNC oxygen therapy for severe COVID-19: a case report

Weihua Lu 1 , ( ), Tao Wang 1, Xuemei Qin 1, Qiancheng Xu 1, Xiaogan Jiang 1   

  1. 1. Department of Critical Care Medicine, Yijishan Hospital, Wannan Medical College, Wuhu 241000, China
  • Received:2021-02-23 Published:2022-02-28
  • Corresponding author: Weihua Lu

在新型冠状病毒肺炎(简称“新冠肺炎”)疫情防控的早期阶段,由于对疾病的认识不足,重症患者治疗难度大、病死率高,这对ICU医师提出了挑战。皖南医学院弋矶山医院在疫情防控早期阶段收治1例重型新冠肺炎患者,结合既往急性呼吸窘迫综合征(ARDS)的处理经验,采用早期清醒俯卧位联合经鼻高流量氧疗(HFNC)治疗,成功避免气管插管和机械通气,最终患者康复出院。本文报告该病例的综合救治过程,并结合文献,分析清醒俯卧位联合HFNC治疗重型新冠肺炎的循证医学依据、注意事项和及时转为有创机械通气的时机,提出“俯卧位前移”的概念,为重症新冠肺炎患者救治提供有力的医疗决策。

In the early stages of COVID-19 prevention and control, due to insufficient understanding of the disease, severe patients were difficult to treat and had a high mortality rate, which posed challenges to ICU physicians. One patient with severe COVID-19 was admitted to our hospital in the early stage of the outbreak. With experiences from the previous management of acute respiratory distress syndrome, the patient was treated with early waking prone position combined with high-flow nasal cannula (HFNC) oxygen therapy. Without endotracheal intubation and mechanical ventilation the patient recovered and was discharged. In this paper, we elaborate the prone position combined with HFNC oxygen therapy together with the comprehensive treatment process of this case. With literature review, we outline the evidence-based basis, notices and timing of invasive mechanical ventilation for awake prone position combined with HFNC in the treatment of severe COVID-19, and summarize the concept of “forward prone position”, which might help making a critical medical decision for the treatment of severe COVID-19 patients.

图1 患者不同时间点胸部CT表现和俯卧位前后SpO2变化。图a为2月2日患者胸部CT结果,提示两肺大量渗出,以中下肺为主;图b为2月12日患者胸部CT结果,较2月2日两肺渗出明显吸收,病变范围明显缩小;图c为2月17日患者胸部CT结果,较前2次进一步好转,渗出明显吸收,病变范围进一步缩小;图d为3月30日(出院后40 d)患者胸部CT结果,胸部渗出完全吸收,无明显纤维化
图2 俯卧位联合HFNC治疗COVID-19患者的流程图 注:SpO2为血氧饱和度;PaO2为动脉血氧分压;FiO2为吸入氧浓度;HFNC为经鼻高流量氧疗
图3 COVID-19患者治疗期间血氧饱和度及氧合指数的变化
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