改良俯卧位方法在ICU ARDS患者俯卧位通气中的应用  

Application of improved prone position method in prone position ventilation of ICU ARDS patients

作　　者：刘会玲[1] 虎于丁 朱君宇[2] 王炜杰[3] 赵滨[1] Liu Huiling;Hu Yuding;Zhu Junyu;Wang Weijie;Zhao Bin(Nursing Department,the Second Hospital of Hebei Medical University,Shijiazhuang 050000,China;The Second Department of Critical Care Medicine,the Second Hospital of Hebei Medical University,Shijiazhuang 050000,China;Medical Records Office,the Second Hospital of Hebei Medical University,Shijiazhuang 050000,China)

机构地区：[1]河北医科大学第二医院护理部,石家庄050000 [2]河北医科大学第二医院重症医学二科,石家庄050000 [3]河北医科大学第二医院病案室,石家庄050000

出　　处：《国际呼吸杂志》2020年第14期1078-1083,共6页International Journal of Respiration

摘　　要：目的探讨改良俯卧位方法在重症监护病房(ICU)急性呼吸窘迫综合征(ARDS)患者俯卧位通气中的应用效果。方法选取2017年7月1日至2018年6月30日于河北医科大学第二医院重症医学二科收治的40例ARDS患者为研究对象,按照患者入院单双号分为对照组和干预组各20例,对照组采用传统俯卧位方法对患者进行俯卧位通气治疗,干预组采用改良俯卧位方法对患者进行俯卧位通气治疗,观察2组患者的动脉血氧饱和度(SaO2)、动脉血氧分压(PaO2)、动脉血二氧化碳分压(PaCO2)、氧合指数(PaO2/FiO2)等指标的差异情况及压伤的发生情况。结果俯卧位前后,2组患者间SaO2、PaO2、PaCO2、PaO2/FiO2等氧合指标,差异均无统计学意义(P值均>0.05)。与俯卧位前比较,对照组与干预组俯卧位后氧合指标显著升高,差异均有统计学意义(P值均<0.05)。干预组患者的压伤发生率(17.64%)明显低于对照组(49.02%),差异有统计学意义(χ^2=5.227,P<0.05),患者胸部是俯卧位通气时压伤的高发部位。结论改良俯卧位方法可有效改善ARDS患者的氧合情况,且能减少ARDS患者俯卧位通气治疗中压伤的发生率,可有效提高临床护理质量及效果,减少患者痛苦,值得临床推广及应用。Objective To investigate the effects of modified prone position method on acute respiratory distress syndrome(ARDS)patients requiring prone position ventilation in intensive care unit(ICU).Methods During July 1st,2017 to June 30th,2018,40 ARDS patients admitted in the Second Department of Critical Care Medicine in the Second Hospital of Hebei Medical University were randomly divided into control group and intervention group with 20 cases in each group based on odd or even admission sequence numbers.The patients of control group and intervention group were respectively treated by traditional prone position ventilation and modified prone position ventilation.Arterial blood oxygen saturation(SaO2),partial arterial oxygen pressure(PaO2),partial carbon dioxide pressure(PaCO2),oxygenation index(PaO2/FiO2)and incidence of pressure injury were recorded and analyzed.Results There was no significant difference(all P>0.05)regarding SaO2,PaO2,PaCO2 and PaO2/FiO2 between two groups before and after application of prone position ventilation.Both groups showed a statistically significant improvement(all P<0.05)of oxygenation related indexes after prone position ventilation.The incidence of pressure injury in intervention group(17.64%)was much lower than that in the control group(49.02%)with a statistically significant difference(χ^2=5.227,P<0.05).The most vulnerable body part to pressure injury during prone position ventilation was chest.Conclusions The modified prone position ventilation can effectively improve the oxygenation of ARDS patients and reduce the incidence of pressure injury associated with prone position ventilation.Meanwhile the improved/modified prone position ventilation can effectively optimize nursing care quality resulting in alleviating patients so it has a value of clinical application and popularization.

关 键 词：呼吸窘迫综合征 成人 护理 改良方法 俯卧位通气 压伤 

分 类 号：R563.8[医药卫生—呼吸系统]