改良俯卧位通气对急性呼吸窘迫综合征机械通气患者氧合指数及皮肤压力性损伤的效果观察  

Effect of modified prone position ventilation on oxygenation index and skin pressure injury in ARDS patients undergoing mechanical ventilation

作　　者：张萃[1] 杨金亮[2] 徐霞 石福霞[1] 张兵 孟思璠 黄惠斌 李鹤 高楠 赵利利 陆镇涛 王学勤[2] ZHANG Cui;YANG Jinliang;XU Xia;SHI Fuxia;ZHANG Bing;MENG Sifan;HUANG Huibin;LI He;GAO Nan;ZHAO Lili;LU Zhentao;WANG Xueqin(ICU,Guang'anmen Hospital,China Academy of Chinese Medical Sciences,Beijing 100053,China;Emergency Department,Guang'anmen Hospital,China Academy of Chinese Medical Sciences,Beijing 100053;General Department,Guang'anmen Hospital,China Academy of Chinese Medical Sciences,Beijing 100053;Nursing Department,Guang'anmen Hospital,China Academy of Chinese Medical Sciences,Beijing 100053)

机构地区：[1]中国中医科学院广安门医院ICU,北京100053 [2]中国中医科学院广安门医院急诊科,北京100053 [3]中国中医科学院广安门医院综合科,北京100053 [4]中国中医科学院广安门医院护理部,北京100053

出　　处：《北京中医药》2024年第11期1266-1270,共5页Beijing Journal of Traditional Chinese Medicine

基　　金：中国中医科学院科技创新工程重大攻关项目(CI2021A03202,CI2021A02906)。

摘　　要：目的评估改良俯卧位通气(PPV)对急性呼吸窘迫综合征(ARDS)机械通气患者氧合指数及皮肤压力性损伤的影响。方法选择2022年12月1日—2023年6月30日中国中医科学院广安门医院ICU收治的56例ARDS患者为研究对象,根据俯卧位通气治疗方式的不同分为常规组、改良组,各28例;根据治疗时间又各分为6 h组和12 h组,各14例。常规组每隔2 h改变头部方向1次,治疗结束后还原平卧位;改良组每隔2 h交替翻身,治疗结束后还原平卧位。对比各组干预前后氧合指数、压力性损伤发生率、压力性损伤严重程度。结果各组干预后氧合指数均高于干预前,改良12 h组、常规12 h组干预前后氧合指数,差异均有统计学意义(P<0.05);改良6 h组、常规6 h组干预前后氧合指数,差异均无统计学意义(P>0.05)。常规组与改良组压力性损伤发生率比较,常规组压力性损伤发生率92.86%(26/28)高于改良组的67.86%(19/28),差异有统计学意义(P<0.05);常规6 h组、常规12 h组、改良6 h组、改良12 h组压力性损伤发生率分别为85.7%(12/14)、100%(14/14)、57.14%(8/14)、78.57%(11/14),各组间对比,差异无统计学意义(P>0.05)。常规6 h组、常规12 h组、改良6 h组、改良12 h组压力性损伤压力性损伤发生部位分别为21、58、14、36处,评分分别为(1.71±1.33)、(7.14±3.21)、(1.43±1.55)、(3.14±2.11)分。常规组压力性损伤评分(7.35±3.92)分高于改良组的(4.00±1.45)分,差异有统计学意义(P<0.05);12 h组压力性损伤发生部位数量、压力性损伤评分均高于6 h组,差异有统计学意义(P<0.05);常规12 h组压力性损伤评分高于改良12 h组,差异有统计学意义(P<0.05);常规6 h组压力性损伤评高于改良6 h组,差异无统计学意义(P>0.05)。结论PPV干预12 h可有效改善ARDS患者的氧合指数,但长时间PPV增加了压力性损伤的风险;改良后的PPV可减少因长时间PPV而造成的压力性损伤。Objective To evaluate the effect of modified prone position ventilation(PPV)on oxygenation index and skin pressure injury in mechanically ventilated patients with acute respiratory distress syndrome(ARDS).Methods A total of 56 ARDS patients treated in the ICU of Guang'anmen Hospital,China Academy of Chinese Medical Sciences,from December 1,2022,to June 30,2023,were selected.According to the mode of PPV treatment,patients were divided into a conventional group and a modified group,with 28 patients in each group.Each group was further divided based on treatment duration into 6-hour and 12-hour subgroups,with 14 patients in each subgroup.The conventional group changed the head position every 2 hours,returning to the supine position after treatment.The modified group alternated turning every 2 hours and also returned to the supine position after treatment.The oxygenation index,incidence of pressure injuries,and severity of pressure injuries were compared before and after the intervention.Results After intervention,the oxygenation index in all groups was higher than that before the intervention.The improvement in the oxygenation index in the modified 12-hour group and conventional 12-hour group showed statistically significant differences(P<0.05).However,no statistically significant differences were observed in the oxygenation index of the modified 6-hour group and conventional 6-hour group(P>0.05).As indicated by the comparison of the incidence of pressure injuries between the conventional and modified groups,the conventional group had a significantly higher incidence(92.86%,26/28)than the modified group(67.86%,19/28)(P<0.05).The incidence rates of pressure injuries in the conventional 6-hour group,conventional 12-hour group,modified 6-hour group,and modified 12-hour group were 85.7%(12/14),100%(14/14),57.14%(8/14),and 78.57%(11/14),respectively,with no significant differences between groups(P>0.05).The number of pressure injury sites in the conventional 6-hour group,conventional 12-hour group,modified 6-hour group,a

关 键 词：压力性损伤 改良俯卧位通气 机械通气 急性呼吸窘迫综合征 

分 类 号：R563.8[医药卫生—呼吸系统]