COPD患者不同卧位及膈肌功能状态对机械通气效果的影响  

Influence of body position and diaphragmatic function on effectiveness of mechanical ventilation in patients with COPD

作　　者：庄耀宁 林彬钦 陈一媛 林德开 林丹丹 郑莉莉 张云 阮炼杰 Zhuang Yaoning;Lin Binqin;Chen Yiyuan;Lin Dekai;Lin Dandan;Zheng Lili;Zhang Yun;Ruan Lianjie(Respiratory Medicine and Intensive Care Unit,Affiliated Hospital of Putian University,Putian 351106,China)

机构地区：[1]莆田学院附属医院呼吸与危重症医学科监护病房,福建莆田351106

出　　处：《护理学杂志》2024年第3期28-30,44,共4页Journal of Nursing Science

基　　金：福建省中青年教师科研项目(JAT210402);莆田市科技计划项目(2023S3F006)。

摘　　要：目的探讨慢性阻塞性肺疾病(COPD)患者有益于机械通气的最佳体位,为临床护理提供实证依据。方法方便抽取120例住院机械通气的COPD患者,采取床旁超声测量平卧位、30°、40°、60°4种卧位膈肌功能状态机械通气效果的参数。结果4种卧位膈肌活动度差异有统计学意义(均P<0.05),其中30~40°卧位膈肌活动度较佳;不同卧位机械通气中,卧位角度越小气道顺应性越好,吸气阻力越高,呼气阻力越低(均P<0.05);卧位角度越小,支持压力越低,通气效果更佳(均P<0.05)。结论COPD患者不同卧位膈肌功能状态及机械通气效果存在明显的趋势变化,一般情况下建议选取30~40°卧位行机械通气。Objective To explore the optimal position for mechanical ventilation in patients with chronic obstructive pulmonary di-sease(COPD),and to provide empirical evidence for clinical nursing practice.Methods A total of 120 COPD patients on mechanical ventilation were selected.Diaphragmatic function was measured using bedside ultrasound when the patient was positioned supine and in 30,40,and 60 degrees Trendelenburg,respectively.Parameters of mechanical ventilation were also recorded.Results There were statistically significant differences in diaphragmatic movement among the four positions(all P<0.05),with better perfor-mance observed in the 30 and 40 degrees Trendelenburg position.In different positions during mechanical ventilation,smaller Trendelenburg position tilt angle was associated with better airway compliance,higher inspiratory resistance,and lower expiratory resistance,as well as lower support pressure and better ventilation effectiveness(all P<0.05).Conclusion There are noticeable trends in the function of the diaphragm and mechanical ventilation effectiveness as a result of the different body postures in COPD patients.In general,it is recommended to choose 30-40 degrees Trendelenburg position for mechanical ventilation.

关 键 词：慢性阻塞性肺疾病 膈肌 机械通气 卧位 呼吸护理 重症护理 

分 类 号：R473.5[医药卫生—护理学]