体外膜肺氧合联合俯卧位一体化治疗的重症患者不同体位测量腹内压的差异性研究  

Differential study on intra-abdominal pressure measurement in severe patients with extracorporeal membrane oxygenation combined with prone position integrated treatment at different positions

作　　者：易金燕[1] 杨丽[2] 钟博华 罗海彬[1] 郭恩慧 韦明尚 Yi Jinyan;Yang Li;Zhong Bohua;Luo Haibin;Guo Enhui;Wei Mingshang(Department of Intensive Care Medicine,the First Affiliated Hospital of Guangxi Medical University,Nanning 530021,China;Department of Nursing,the First Affiliated Hospital of Guangxi Medical University,Nanning 530021,China)

机构地区：[1]广西医科大学第一附属医院重症医学科,南宁530021 [2]广西医科大学第一附属医院护理部,南宁530021

出　　处：《中国实用护理杂志》2024年第27期2081-2089,共9页Chinese Journal of Practical Nursing

基　　金：广西壮族自治区卫生健康委员会自筹经费科研课题(Z20200905)。

摘　　要：目的对比分析体外膜肺氧合(ECMO)联合俯卧位一体化治疗的重症患者不同体位测量腹内压的差异,以期寻找更优化的腹内压监测策略,为临床诊断和治疗提供理论依据。方法采用自身对照试验的方法,以便利抽样法选取2020年1月至2023年6月在广西医科大学第一附属医院重症医学科行ECMO联合俯卧位一体化治疗的40例重症患者为研究对象。对比分析仰卧位床头抬高0°、15°、30°与俯卧位头高足低斜坡0°、15°、30°腹内压的差异性。同时比较患者处于不同体位下的心率、呼吸频率、平均动脉压和血氧饱和度。结果40例患者中男29例,女11例,年龄为(62.58±17.99)岁。患者仰卧位床头抬高30°的腹内压为(12.45±3.43)mmHg(1 mmHg=0.133 kPa),均高于0°、15°的(9.38±2.52)、(10.70±2.95)mmHg,差异均有统计学意义(t=4.56、2.45,均P<0.05),0°和15°的腹内压比较差异无统计学意义(P>0.05);俯卧位头高足低斜坡30°的腹内压为(12.92±4.19)mmHg,均高于0°、15°的(9.67±2.80)、(11.01±3.10)mmHg,差异均有统计学意义(t=4.08、2.32,均P<0.05),0°和15°的腹内压比较差异无统计学意义(P>0.05)。仰卧位床头抬高0°、15°、30°与俯卧位头高足低斜坡0°、15°、30°的腹内压比较,差异均无统计学意义(均P>0.05)。仰卧位床头抬高0°、15°、30°的心率、呼吸频率、平均动脉压及血氧饱和度比较,差异均无统计学意义(均P>0.05);俯卧位头高足低斜坡0°、15°、30°的心率、呼吸频率、平均动脉压及血氧饱和度比较,差异均无统计学意义(均P>0.05);仰卧位床头抬高0°、15°、30°与俯卧位头高足低斜坡0°、15°、30°的心率、呼吸频率、平均动脉压比较,差异均无统计学意义(均P>0.05);仰卧位床头抬高0°、15°、30°与俯卧位头高足低斜坡0°、15°、30°的血氧饱和度比较,差异均有统计学意义(Z=6.85、6.82、6.68,均P<0.05)。结论ECMO联合俯卧位一体化治疗的重症患者Objective To compare and analyze the differences in the measurement of intra-abdominal pressure in different positions of critically ill patients treated with extracorporeal membrane oxygenation(ECMO)combined with prone position integration,with a view to finding a more optimal intra-abdominal pressure monitoring strategy,which can provide a theoretical basis for clinical diagnosis and treatment.Methods Forty critically ill patients who underwent ECMO combined with prone position integrated treatment in the department of Intensive Care Medicine of the First Affiliated Hospital of Guangxi Medical University from January 2020 to June 2023 were selected by convenience sampling method using an own-control trial.The differences in intra-abdominal pressure between supine position with head elevated at 0°,15°and 30°and prone position with head high and foot low slopes at 0°,15°and 30°were compared and analyzed.Heart rate,respiration,mean arterial pressure and oxygen saturation were also compared in patients in different positions.Results There were 29 males and 11 females in 40 patients with the age of(62.58±17.99)years.The intra-abdominal pressure in supine position with head elevated at 30°was(12.45±3.43)mmHg(1 mmHg=0.133 kPa),which was higher than that of 0°and 15°of(9.38±2.52)and(10.70±2.95)mmHg,and the differences were statistically significant(t=4.56,2.45,both P<0.05);the difference in intra-abdominal pressure between 0°and 15°was not statistically significant(P>0.05);the intra-abdominal pressure in prone position with head-high-foot-low slope of 30°was(12.92±4.19)mmHg,which was higher than that of 0°and 15°of(9.67±2.80),and(11.01±3.10)mmHg,and the differences were statistically significant(t=4.08,2.32,both P<0.05);the difference in intra-abdominal pressure between 0°and 15°was not statistically significant(P>0.05).The differences in intra-abdominal pressure between groups of supine bed head elevation 0°,15°,30°and prone position with head high and foot low slopes 0°,15°,30°were not st

关 键 词：体外膜氧合作用 俯卧位 腹内压 测量 

分 类 号：R459.7[医药卫生—急诊医学]