改良式俯卧位通气对ARDS患者压力性损伤的影响

doi:10.3969/j.issn.2095-9400.2020.06.012

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摘要目的：观察改良式俯卧位通气（PPV）对急性呼吸窘迫综合征（ARDS）患者压力性损伤（PI）的效果。方法：选取2015年1月至2019年1月在温州医科大学附属第二医院重症医学科需PPV的ARDS患者68例，按随机数字表法分为常规组和改良组。常规组33例，采取0°持续PPV 16 h；改良组35例，采用头高脚低30°俯卧，左、右30°侧俯卧交替进行，每个体位维持2 h，16 h后改为仰卧位。比较2组俯卧位后PI发生率、数量、部位和分期。结果：常规组14例患者发生了47处PI，其中1期26处，2期21处；改良组6例发生15处PI，1期10处，2期5处；常规组PI发生率为42.42%（14/33），改良组为17.14%（6/35）。2组PI的发生率和分期比较差异均有统计学意义（P＜0.05）。结论：应用改良式PPV可以减少ARDS患者PI的发生率。

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	郑晓倩
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	张晓隆

关键词 ：急性呼吸窘迫综合征, 俯卧位通气, 压力性损伤

Abstract：Objective: To investigate the effect of modified prone position ventilation on pressure injury of ARDS patients. Methods: During January 2015 to January 2019, 68 patients required prone position ventilation in the Department of Anesthesia and Critical Care were included in our study. The patients were randomly divided into the control group (n=33) and the intervention group (n=35). Patients in the control group received ventilation in 0° continuous prone position for 16 hours. In the intervention group, 35 patients were placed in 30° left lateral prone position and 30° right lateral prone position alternately, and each position was maintained for 2 hours with the head of bed elevated 30°. After 16 hours, the patients were changed to supine position. The incidence of pressure injury in different locations and stages were compared between two groups. Results: We found 47 pressure injuries that occurred in 14 patients in the control group including 26 injuries in stage 1 and 21 in stage 2. Importantly, total 15 pressure injuries were found in intervention group including 10 injuries in stage 1 and 5 in stage 2. The incidence of pressure injury was 42.42% in the control group while 17.14% in intervention group. There were statistical differences in the incidence of pressure injury in different locations and stages between the two groups (P<0.05). Conclusion: The results suggest that the modified prone position ventilation could reduce the incidence of pressure injury.

Key words： acute respiratory distress syndrome prone position ventilation pressure injury

收稿日期: 2019-11-14

基金资助:浙江省自然科学基金资助项目（LY20H150003）；温州市科技局科研基金资助项目（Y20140670）。

通讯作者: 张晓隆，副主任医师，Email：zxl307@126.com。

作者简介: 郑晓倩（1980-），女，浙江金华人，主管护师。

链接本文:

https://xb.wmu.edu.cn/CN/10.3969/j.issn.2095-9400.2020.06.012 或 https://xb.wmu.edu.cn/CN/Y2020/V50/I6/489

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