Abstract： Objective To study the efficacy oftransnasal high-flow oxygen therapy combined with prone venti-lation in awake patients with COVID.Methods Eighty-seven sober patients with COVID of our hospital were selected and divided into two groups by random number table method from March 2022 to February 2023.The two groups were treated with antiviral,anti-inflammatory,anti-inflammatory,cough and phlegm.In the control group,forty-two patients were ventilated with conventional oxygen inhalation and supine position,and forty-five patients in the observation group were ventilated bytransnasal high flow oxygen inhalation and prone posi-tion.The following indexes were respectively compared between the two groups,such as blood oxygen satura-tion(SpO2),oxygen partial pressure(PaO2)and oxygenation index(PaO2/FiO2).C-reactive protein(CRP)and Procalcitonin(PCT)were compared,and complications such as reflux,vomiting and pressure sore were compared between the two groups during treatment.Results After treatment,the indexes of blood oxygen saturation(SpO2),oxygen partial pressure(PaO2)and oxygenation index(PaO2/FiO2)in the study group were better than those in the conventional treatment group,and the difference was statistically significant(P＜0.05).The C-reactive protein(CRP)and Procalcitonin(PCT)indexes in the treatment group were signifi-cantly lower than those in the conventional treatment group,and the difference was statistically significant(P＜0.05).The incidence of complications in the observation group during the treatment period was not com-pared with the control group,there was no statistically significant difference(P＞0.05).Conclusion Tran-snasal high-flow oxygen therapy combined with prone ventilation can effectively improve oxygen saturation and partial oxygen pressure,effectively improve lung function,improve inflammatory response,and improve the cure effect in awake patients with COVID.