不同卧位角度在重症患者机械通气中的应用效果分析  

Effects of different angles of semirecumbent positions on critically ill patients undergoing mechanical ventilation

作　　者：李福琴[1] 高姗[1] 杨阳[1] 湛玉晓 黄云鹏[1] 

机构地区：[1]郑州大学第一附属医院感染管理科,河南郑州450052

出　　处：《中华医院感染学杂志》2015年第21期4911-4913,共3页Chinese Journal of Nosocomiology

基　　金：中国医院协会医院感染预防与控制能力建设基金资助项目(CHA-2012-XSPX-0629-1)

摘　　要：目的探讨不同卧位角度在重症患者机械通气中的应用效果,指导临床采用合理体位,降低呼吸机相关性肺炎(VAP)及胃内容物反流(GER)发生率,并提高压疮预防有效率和患者舒适度。方法选取2013年10月-2014年10月在郑州大学第一附属医院急诊重症监护病房(EICU)使用机械通气的357例成年患者作为研究对象,根据抬高床头角度不同,随机分为0°、30°、45°3组进行观察,每组各119例,比较不同组VAP、GER以及压疮预防有效率、并进行患者舒适度的调查,采用SPSS19.0软件进行统计分析。结果 0°组、30°组、45°组VAP发生率分别为14.29%、4.20%、3.36%,0°组VAP发生率与30°组、45°组相比差异有统计学意义(P<0.05),其中30°组与45°组的VAP发生率差异无统计学意义,均能有效降低VAP的发生率;0°组、30°组、45°组GER发生率分别为19.33%、7.56%、13.45%,压疮预防有效率分别为60.50%、84.87%、77.31%,舒适度分别为37.82%、81.51%、62.18%,3组间各项指标比较差异均有统计学意义(P<0.05)。结论 30°床头角度在预防呼吸机相关性肺炎和胃内容物反流发生的同时,又能保证压疮的有效预防和提高患者的舒适度,是机械通气患者较理想的体位。OBJECTIVE To evaluate the effects of different angles of semirecumbent positions on critically ill patients undergoing mechanical ventilation so as to adopt the reasonable semirecumbent position,reduce the incidence of ventilator-associated pneumonia（VAP）and gastro esophageal reflux（GER）,and raise the effective rate of prevention of high pressure sores and comfort level of the patient.METHODS A total of 357 adult patients who underwent the mechanical ventilation in the emergency intensive care unit（EICU）of The First Affiliated Hospital of Zhengzhou University from Oct 2013 to Oct 2014 were recruited as the study objects and randomly divided into the group 0°,30°,and 45°according to the elevated angle of bed head,with 119 cases in each group.The incidence of VAP,GER,and effective rate of prevention of pressure ulcers were compared,the comfort levels of the patients were investigated,and the statistical analysis was performed with the use of SPSS19.0software.RESULTS The incidence of VAP was 14.29%in the group 0°,4.20%in the group 30°,3.36%in the group 45°,there was statistically significant difference in the incidence of VAP between the group 0°and the group 30°,the group 45°（P〈0.05）,while there was no statistically significant difference in the incidence of VAP between the group 30°and the group 45°,all were able to effectively reduce the incidence of VAP.The incidence of GER was 19.33% in the group 0°,7.56%in the group 30°,13.45%in the group 45°.The effective rate of prevention of pressure ulcers was 60.50%in the group 0°,84.87%in the group 30°,77.31%in the group 45°.The comfort level was 37.82%in the group 0°,81.51%in the group 30°,62.18%in the group 45°,and there was statistically significant difference in the indicators among the three groups（P〈0.05）.CONCLUSION The angle of bed head of 30°can not only prevent the VAP and GER but also effectively prevent the pressure ulcers and improve the comfort levels of the patients,and it is an ideal semirecumbent position for

关 键 词：卧位 呼吸机相关性肺炎 胃内容物反流 压疮 舒适度 

分 类 号：R181.32[医药卫生—流行病学]