肺部超声引导的体位策略联合定位振肺在老年体外循环术后病人中的应用  

Application of lung ultrasound-guided posture strategy combined with localized lung vibration in elderly patients after cardiopulmonary bypass

作　　者：嵇曼斐 祁萍 陈静[1] 徐淮金 张国新[1] 陈久栋 洪亮[1] JI Man-fei;QI Ping;CHEN Jing;XU Huai-jin;ZHANG Guo-xin;CHEN Jiu-dong;HONG Liang(Department of Intensive Care Unit,Nangjing First Hospital,Nanjing Medical University,Nanjing 210006,China)

机构地区：[1]南京医科大学附属南京医院(南京市第一医院)重症医学科,江苏省南京市210006

出　　处：《实用老年医学》2023年第9期968-972,共5页Practical Geriatrics

基　　金：南京市医学重点科技发展项目(ZKX19021)。

摘　　要：目的探讨肺部超声引导的体位策略联合定位振肺在老年体外循环术后病人中的应用效果。方法选取2022年6~11月南京市第一医院ICU住院的老年体外循环术后病人128例,随机分为对照组和观察组,每组64例。对照组实施常规体位摆放和肺部叩击振动,观察组在肺部超声引导下实施个性化体位策略和针对性肺部叩击振动。比较2组病人肺部超声评分、氧合指数、排痰量、机械通气时间和ICU住院时间。结果观察组术后第2天开始肺部超声评分低于对照组,氧合指数高于对照组,差异有统计学意义(P<0.05);术后24 h排痰量明显高于对照组,差异有统计学意义(P<0.05)。观察组的机械通气时间和ICU住院时间均比对照组缩短,差异有统计学意义(P<0.05)。结论肺部超声引导的体位策略和定位振肺可以促进体外循环术后的老年病人排出痰液,改善肺部功能和氧合状态,缩短机械通气时间和ICU住院时间。Objective To explore the effect of posture strategy combined with localized lung vibration guided by lung ultrasound in the elderly patients after cardiopulmonary bypass.Methods From June to November 2022,128 elderly patients who were admitted to intensive care unit(ICU)of Nanjing First Hospital after cardiopulmonary bypass were randomly divided into control group(n=64)and observation group(n=64).The control group carried out routine posture placement and lung percussion and vibration,while the observation group carried out personalized posture strategy and targeted lung percussion and vibration under the guidance of lung ultrasound.The lung ultrasound score,oxygenation index,sputum output,mechanical ventilation time and ICU hospitalization time of the two groups were compared.Results The lung ultrasound score was significantly lower,and the oxygenation index was significantly higher in the observation group than that in the control group from the second day after the operation(P<0.05).The sputum output in the observation group 24 h after operation was significantly higher than that in the control group(P<0.05);The mechanical ventilation time and ICU hospitalization time in the observation group were significantly shorter than those in the control group(P<0.05).Conclusions The posture strategy and localized lung vibration guided by lung ultrasound can promote the sputum excretion in the elderly patients after cardiopulmonary bypass,improve lung function and oxygenation status,and shorten the time of mechanical ventilation and ICU hospitalization time.

关 键 词：肺部超声 体位策略 定位振肺 老年人 体外循环 

分 类 号：R473.6[医药卫生—护理学]