机械通气危重病人卧位与中心静脉压的关系研究  

Study on relationship between decubitus position of severe patients with mechanical ventilation and their central venous pressure

作　　者：李美晨 陈训婷 仇丽霞[1] LI Meichen;CHEN Xunting;QIU Lixia(School of Public Health,Shanxi Medical University,Shanxi 030001 China)

机构地区：[1]山西医科大学公共卫生学院,山西030001 [2]大同市第五人民医院

出　　处：《护理研究》2023年第6期975-979,共5页Chinese Nursing Research

基　　金：国家自然科学基金资助项目,编号:81973155。

摘　　要：目的:探讨机械通气危重病人不同卧位与中心静脉压(CVP)的关系。方法:选取大同市某三级甲等医院重症医学科收治的9例机械通气危重病人作为研究对象,每日4个固定时点进行4种卧位的CVP测量,选择不确定作业相关矩阵建立广义估计方程。结果:卧位与CVP测量值有关,床头抬高30°半卧位与平卧位CVP值差异无统计学意义(P=0.272),两种卧位CVP值高度相关(r=0.751,P<0.001);床头抬高30°左侧30°卧位CVP值比平卧位约低5.564 cmH 2O(P<0.001),偏差较大;床头抬高30°右侧30°卧位的CVP值比平卧位约低0.800 cmH 2O(P=0.031),在21:00测量、年龄较大及床头抬高30°右侧30°卧位的CVP值较大、心率和呼吸频率较快、24 h出入量较少,平卧位的CVP值较高,且广义估计方程对平卧位的CVP值预测效果好于用床头抬高30°右侧30°卧位的CVP值直接替代(t=2.181,P=0.033)。结论:不能采用平卧位测量CVP值的机械辅助通气危重病人可首先考虑将床头抬高30°半卧位的CVP值作为平卧位CVP值的估计值;其次,可考虑采取床头抬高30°右侧30°卧位测量CVP值,并利用本研究提出的预测模型对平卧位CVP值进行估计。Objective:To explore relationship between decubitus position of severe patients with mechanical ventilation and their central venous pressure(CVP).Methods:Nine severe patients with mechanical ventilation admitted to department of critical care medicine of a tertiary grade A hospital in Datong city were selected as study subjects.CVP was measured at four fixed time points every day with four kinds of decubitus position.Generalized estimating equations was established by selecting uncertain operation correlation matrix.Results:Decubitus position was related to CVP measurement.There was no significant difference in CVP values between half decubitus position with head of the bed raised by 30°and supine position(P=0.272),and the CVP values of the two decubitus position were highly correlated(r=0.751,P<0.001).The CVP value of position with head of the bed raised by 30°combined with left side decubitus 30°was about 5.564 cmH2O lower than that of the supine position(P<0.001),with a large deviation.The CVP value of position with head of the bed raised by 30°combined with right side decubitus 30°was about 0.800 cmH2O lower than that of the supine position(P=0.031),When measured at 21:00,became older,and the CVP value was higher in position with head of the bed raised by 30°combined with right side decubitus 30°,the heart rate and respiratory rate were faster in position with head of the bed raised by 30°combined with right side decubitus 30°,24 h input and output amount was less,the CVP value of supine position was higher.The predictive effect of generalized estimating equations on CVP value of supine position was better than that of direct substitution with CVP value of position with head of the bed raised by 30°combined with right side decubitus 30°(t=2.181,P=0.033).Conclusions:Severe patients with mechanical ventilation who can not measure CVP value in supine position can consider take the CVP value of half decubitus position with head of the bed raised by 30°as the estimated value of the CVP value of supine

关 键 词：机械通气 危重病人 中心静脉压 体位 广义估计方程 护理 

分 类 号：R472.2[医药卫生—急诊医学]