影响机械通气患者床头抬高角度不足的因素（中国ICU多中心调查）  

Influencing factor of the head - of - bed elevated insufficiently in patients with mechanical ventilation： mniticenter survey in Chinese ICUs

作　　者：刘京涛[1] 宋海晶[2] 王宇[1] 马朋林[1] 

机构地区：[1]解放军第309医院急救部ICU,北京100091 [2]解放军第306医院急诊科,北京100091

出　　处：《中国急救医学》2011年第2期114-119,共6页Chinese Journal of Critical Care Medicine

基　　金：首发基金重点项目（No.2009-2045）

摘　　要：目的通过多中心、前瞻性抽样调查，了解我国ICU中影响机械通气患者床头抬高临床依从性的因素。方法2009—06—11～2009—07—31在全国34个三级甲等医院ICU中连续选择年龄18～80周岁、无体位受限、意识清楚、接受机械通气（气管插管）时间348h的患者，在每个机械通气日值班医生分4次测量实际床头抬高角度，测量间隔为5—7h。床头抬高达标次数指患者在每个机械通气日内达到床头抬高≥30°的次数。结果本研究对314例入选患者在共计2842个机械通气日内进行了8647次床头抬高角度的检测，床头抬高≥30°次数为2403次，仅27．79％。床头抬高≥30°达标≥3次／d的患者仅15．92％（50／314），而达标0次／d的患者58．92％（185／314）。10家参研医院所有人选患者的床头抬高≥30°达标情况均为0次／d，而所有入选患者满足达标〉13次／d的医院仅1家。床头抬高≥30°的临床依从性与疾病分类、APACHEⅡ评分以及是否依赖血管活性药物无密切关系，而随机抽取每家参研单位5名医生和10名护士进行预防呼吸机相关肺炎（VAP）相关知识的问卷调查显示，知晓IHI呼吸机捆绑治疗（Ventilator Bundle）的医生仅为27．9％，护士不足10％。床头抬高≥30°临床依从性高的患者机械通气时间较依从性低者显著缩短（P〈0．01），并且VAP发生率显著降低（P〈0．05）。结论中国三级甲等教学医院ICU中，医护人员预防VAP的相关知识普遍欠缺，是影响床头抬高≥30°临床依从性的关键因素。Objective The propose of this study is to investigate the factors of clinical low adherence of head - of - bed elevation （HOBE） in mechanically ventilated patients in Intensive Care Units through a prospective, multicenter survey in China. Methods Patients, aged 18 - 80, received invasive mechanical ventilation over 48 hours, with clear consciousness and without the limitation of immobilization were consecutively recruited from ICUs of thirty four Chinese academic hospital from June 11, 2009 to July 31, 2009. Daily 4 measurements of the real angle of the HOBE with a 5 -7 hours intervals were personally perfonned by the physician on duty and confirmed by the nurse in charge of the bed. We defined the times up to the goal of head - of - bed elevation （ i.e. goal times/day ） as the minimum measurements with HOBE higher than 30° in each ventilated day within all ventilation days in one patient. Results The angle of HOBE higher than 30° were found for 27.79% （2403/8647） in 314 enrolled cases during a total number of 2842 ventilation days. 15.92% （50/314） of cases were up to goal of HOBE ≥3 times/day. On the other hand, 58.92% （185/314） of cases achieved 0 goal time/ day. All enrolled cases had 0 times/day on the goal of HOBE in 10 participated centers. There was only one center, in which HOBE up to goal ≥ 3 times/day were measured in all patients. Low clinical compliance of HOBE≥30° was not associated with APACHE Ⅱ score, categories of diseases and whether or not dependent on vasopressors in ventilated patients. Results of the questionnaire survey, carried out in randomly selected 10 nurses and 5 physicians in each participated ICU, showed that only 27.9% physicians and less than 10% of nurses understood IHI （ Institute of Heahhcare Improvement） ventilator bundle. It was also identified that patients with high compliance of HOBE ≥30° had the shorter ventilation duration （P 〈 0. 01 ） and the lower incidence of ventilator- associated pneumonia（VAP） （ P 〈 0.05 ）. Conc

关 键 词：床头抬高 临床依从性 呼吸机相关性肺炎 

分 类 号：R472.9[医药卫生—护理学]