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  • 陈锐勇,唐艳超,仲小玲,梁奕,李卜军,陶晓岚,廖昌波.高压氧治疗在重型新型冠状病毒肺炎患者救治中的疗效分析[J].第二军医大学学报,2020,41(6):604-611    [点击复制]
  • CHEN Rui-yong,TANG Yan-chao,ZHONG Xiao-ling,LIANG Yi,LI Bu-jun,TAO Xiao-lan,LIAO Chang-bo.Efficacy analysis of hyperbaric oxygen therapy in the treatment of severe coronavirus disease 2019 patients[J].Acad J Sec Mil Med Univ,2020,41(6):604-611   [点击复制]
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高压氧治疗在重型新型冠状病毒肺炎患者救治中的疗效分析
陈锐勇1△,唐艳超2△,仲小玲3,梁奕*4,李卜军5,陶晓岚3,廖昌波6
0
(1. 海军军医大学(第二军医大学)海军特色医学中心潜水与高气压医学研究室, 上海 200433;
2. 空军杭州特勤疗养中心疗养三区, 杭州 310002;
3. 长江航运总医院高压氧科, 武汉 430010;
4. 长江航运总医院CT室, 武汉 430010;
5. 长江航运总医院重症监护室, 武汉 430010;
6. 海军军医大学(第二军医大学)海军特色医学中心援潜救生医学与装备技术训练队, 上海 200433
共同第一作者
*通信作者)
摘要:
目的 分析重型新型冠状病毒肺炎(COVID-19)患者高压氧治疗(HBOT)的疗效及潜在机制。方法 选择长江航运总医院收治的5例重型COVID-19患者,年龄为24~69岁,因常规治疗不能控制病情且存在进行性低氧血症而接受HBOT。HBOT方法:每天1次,15 min匀速加压至2.0 ATA(表压0.1 MPa,患者1)或1.6 ATA(表压0.06 MPa,患者2~5),持续停留90 min(首次治疗)或60 min(随后治疗),然后20 min减压至常压;HBOT全程无间歇面罩吸氧;病房脉搏血氧饱和度(SpO2)日均值连续2 d超过95%结束HBOT。收集患者症状、呼吸频率、SpO2、动脉血气分析结果、血常规、凝血功能、高敏C-反应蛋白(hs-CRP)和胸部CT检查结果等资料。采用配对t检验比较治疗前后各指标的差异。结果 首次HBOT治疗后所有患者症状、体征均开始好转。开始HBOT 4次后平卧位呼吸急促消失,5次后消化道症状完全消失,仅残存轻微胸痛、静息和活动状态下呼吸急促症状。结束HBOT疗程后,患者呼吸频率较HBOT前下降[(20.80±2.28)min-1 vs (27.20±5.40)min-1P<0.05]。病房监测SpO2均在引入HBOT后逐日回升,5例患者日平均SpO2分别在第1、2、3、3、6次HBOT后恢复至95%以上。首次HBOT减压后SpO2为(93.60±0.07)%,高于加压前的(73.20±6.42)%(P<0.05),第2、3次HBOT加压前SpO2与首次加压前相比均升高(P均<0.05),第3次HBOT前后即刻相比差异无统计学意义(P>0.05)。HBOT前,患者的动脉血二氧化碳分压(PaCO2)为(31.48±3.40)mmHg(1 mmHg=0.133 kPa),低于正常参考值(35~ 45 mmHg)。HBOT疗程结束后动脉血氧分压[(130.20±18.58)mmHg]、动脉血氧饱和度[(98.40±0.55)%]、淋巴细胞比例[(0.207 8±0.074 2)]和淋巴细胞绝对值[(1.09±0.24)×109/L]均较HBOT前[(61.60±15.24)mmHg、(73.20±6.43)%、0.094 6±0.062 1、(0.61±0.35)×109/L]升高,纤维蛋白原水平[(2.97±0.27)g/L]和hs-CRP水平[(7.76±6.95)mg/L]均较HBOT前[(4.45±0.94)g/L、(30.36±1.27)mg/L]降低,差异均有统计学意义(P均<0.05);血乳酸和D-二聚体水平均回降[(1.13±0.10)mmol/L vs (2.17±1.71)mmol/L、(0.42±0.13)mg/L vs(1.84±1.29)mg/L],但差异均无统计学意义(P均>0.05)。患者HBOT前均有重型COVID-19典型肺部CT影像学改变,HBOT后均有所改善。结论 持续性低氧血症诱发的全身性系统性缺氧或许是重型COVID-19患者病情恶化的主要原因。COVID-19患者呼吸功能障碍以肺泡换气功能障碍为主,HBOT可能是纠治重型COVID-19患者常压给氧无法控制的进行性低氧血症的最佳手段。HBOT为处于持续缺氧的机体组织提供了充足氧供的有氧代谢间歇,有利于机体免疫功能、循环功能、应激水平的恢复,从而促进病情好转。
关键词:  新型冠状病毒肺炎|氧吸入疗法|高压氧|低氧
DOI:10.16781/j.0258-879x.2020.06.0604
投稿时间:2020-04-06修订日期:2020-04-20
基金项目:海军特色医学中心科学战“疫”快速响应专项(20M0201).
Efficacy analysis of hyperbaric oxygen therapy in the treatment of severe coronavirus disease 2019 patients
CHEN Rui-yong1△,TANG Yan-chao2△,ZHONG Xiao-ling3,LIANG Yi*4,LI Bu-jun5,TAO Xiao-lan3,LIAO Chang-bo6
(1. Department of Diving and Hyperbaric Medical Research, Naval Special Medical Center, Naval Medical University (Second Military Medical University), Shanghai 200433, China;
2. The Third District of Air Force Special Service Sanatorium, Hangzhou 310002, Zhejiang, China;
3. Department of Hyperbaric Oxygen, General Hospital of the Yangtze River Shipping, Wuhan 430010, Hubei, China;
4. CT Room, General Hospital of the Yangtze River Shipping, Wuhan 430010, Hubei, China;
5. Intensive Care Unit, General Hospital of the Yangtze River Shipping, Wuhan 430010, Hubei, China;
6. Military Diving Rescue and Equipment Technique Training Center, Naval Special Medical Center, Naval Medical University (Second Military Medical University), Shanghai 200433, China
Co-first authors.
* Corresponding author)
Abstract:
Objective To explore the potential mechanisms underlying the prominent efficiency of hyperbaric oxygen therapy (HBOT) in the treatment of severe coronavirus disease 2019 (COVID-19) patients. Methods Five COVID-19 patients, aged from 24 to 69 years old, received HBOT after routine therapies failed to stop the deterioration and progressive hypoxemia in General Hospital of the Yangtze River Shipping. The procedure of HBOT was as follows:compressed to 2.0 ATA (0.1 MPa gauge pressure, patient 1) or 1.6 ATA (0.06 MPa gauge pressure, patient 2-5) at a constant rate for 15 min, maintained for 90 min (first treatment) or 60 min (subsequent treatment), then decompressed to normal pressure for 20 min, once a day; the patients inhaled oxygen with the mask of Built-in-Breathing System continuously; and HBOT was ended when the daily mean pulse oxygen saturation (SpO2) in wards was above 95% for two days. The symptoms, respiratory rate (RR), SpO2, arterial blood gas analysis, blood routine, coagulation function, high-sensitivity C-reactive protein (hs-CRP) and chest computed tomography (CT) were collected. Paired t test was used to compare each index before and after treatment. Results After the first HBOT, the symptoms and signs of the five patients began to improve. Supine breathlessness disappeared after HBOT for four times, and digestive tract symptoms completely disappeared and only mild chest pain and breathlessness at rest and in motion remained after HBOT for five times. After finishing HBOT, the RR of the patients was significanlty lower than that before HBOT ([20.80±2.28] min-1 vs[27.20±5.40] min-1, P<0.05). After finishing HBOT, daily SpO2 in wards was increased day by day, and the daily mean SpO2 recovered to more than 95% after the first, second, third, third and sixth HBOT in the five patients, respectively. After the first HBOT decompression, SpO2 was (93.60±0.07)%, which was signficantly higher than that before HBOT ([73.20±6.42]%) (P<0.05). SpO2 values before compression of the second and third HBOT were signficantly higher than that before the first HBOT (both P<0.05). There was no significant difference in the SpO2 immediately before and after the third HBOT (P>0.05). Before HBOT, the arterial partial pressure of carbon dioxide (PaCO2) of the patients was (31.48±3.40) mmHg (1 mmHg=0.133 kPa), which was lower than the normal range (35-45 mmHg). After finishing HBOT, arterial partial pressure of oxygen ([130.20±18.58] mmHg), arterial oxygen saturation ([98.40±0.55]%), lymphocyte proportion (0.207 8±0.074 2) and lymphocyte count ([1.09±0.24]×109/L) were significantly higher than those before HBOT ([61.60±15.24] mmHg,[73.20±6.43]%, 0.094 6±0.062 1, and[0.61±0.35]×109/L), while the levels of fibrinogen ([2.97±0.27] g/L) and hs-CRP ([7.76±6.95] mg/L) were significantly lower than those before HBOT ([4.45±0.94] g/L and[30.36±1.27] mg/L) (all P<0.05). The levels of lacttic acid and D-dimer were decreased after HBOT versus before HBOT ([1.13±0.10] mmol/L vs[2.16±1.71] mmol/L,[0.42±0.13] mg/L vs[1.84±1.29] mg/L), but the differences were not significant (both P>0.05). All the five patients had typical lung CT imaging changes of severe COVID-19 before HBOT, which were improved after HBOT. Conclusion Systemic hypoxia induced by persistent hypoxemia may be the main reason for the deterioration of severe COVID-19. The respiratory dysfunction of COVID-19 is mainly alveolar gas exchange dysfunction. HBOT may be the best way to correct the progressive hypoxemia which can not be controlled by atmospheric oxygen supply in severe COVID-19 patients. HBOT can provide enough oxygen supply for the continuous hypoxia tissues, and is beneficial to the recovery of immune function, circulatory function and stress level, so as to improve the condition of patients.
Key words:  coronavirus disease 2019|oxygen inhalation therapy|hyperbaric oxygenation|hypoxia