清醒俯卧位在新型冠状病毒肺炎非插管患者中的应用现状与展望

doi:10.3877/cma.j.issn.1674-6880.2022.06.019

新型冠状病毒肺炎（corona virus disease 2019，COVID-19）的传播已被世界卫生组织认定为全球大流行^[1]，很多感染患者没有症状或者只有轻微流感症状，然而接近14%的患者会发生病情进展，如出现低氧性呼吸衰竭或急性呼吸窘迫综合征（acute respiratory distress syndrome，ARDS）^[2]。对于已插管的中重度ARDS患者，俯卧位是一种提升氧合、降低病死率的有效疗法^[3-4]。在一些观察性的研究中，清醒俯卧位已被用来提升非插管ARDS患者的氧合，近年来，其在COVID-19患者中开始广泛应用^[5-7]。目前由于缺少大样本、高质量的随机对照研究，国际上对于清醒俯卧位究竟能否降低COVID-19低氧性呼吸衰竭患者的插管率、病死率以及改善远期预后等方面仍存在不少争议^[8]，然而众多研究均对清醒俯卧位实施的安全性和可行性给出了一致的肯定性结论^[9-11]。由于呼吸机的短缺、重症医疗资源的有限，这种简单、安全、经济、无创性的体位疗法在未来拥有巨大的研究前景^[12]。目前，许多国际知名组织已经将清醒俯卧位作为预防COVID-19患者气管插管、改善远期预后的推荐治疗手段^[13-14]。

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