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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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

Received: 14 November 2019

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	ZHENG Xiaoqian
	LI Aidan
	CHEN Wangfeng
	LIN Xiaowen
	ZHANG Xiaolong

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

[1] ARDS Definition Task Force, RANIERI V M, RUBENFELD G D, et al. Acute respiratory distress syndrome: the Berlin Definition[J]. JAMA, 2012, 307(23): 2526-2533.
[2] SUD S, FRIEDRICH J O, ADHIKARI N K, et al. Effect of prone positioning during mechanical ventilation on mortality among patients with acute respiratory distress syndrome: a systematic review and meta-analysis[J]. CMAJ, 2014, 186(10): E381-E390.
[3] EDSBERG L E, BLACK J M, GOLDBERG M, et al. Revised national pressure ulcer advisory panel pressure injury staging system: revised pressure injury staging system[J]. J Wound Ostomy Continence Nurs, 2016, 43(6): 585-597.
[4] GUÉRIN C. Prone positioning acute respiratory distress syndrome patients[J]. Ann Transl Med, 2017, 5(14): 289.
[5] PIEHL M A, BROWN R S. Use of extreme position changes in acute respiratory failure[J]. Crit Care Med, 1976, 4(1): 13-14.
[6] KALLET R H. Comprehensive review of prone position in ARDS[J]. Respir Care, 2015, 60(11): 1660-1687.
[7] GUERIN C, REIGNIER J, RICHARD J C, et al. Prone positioning in severe acute respiratory distress syndrome[J]. N Engl J Med, 2013, 368(23): 2159-2168.
[8] MUNSHI L, DEL SORBO L, ADHIKARI N K J, et al. Prone position for acute respiratory distress syndrome. A systematic review and meta-analysis[J]. Ann Am Thorac Soc, 2017, 14 (Supplement 4): S280-S288.
[9] GHELICHKHANI P, ESMAEILI M. Prone position in management of COVID-19 patients; a commentary[J]. Arch Acad Emerg Med, 2020, 8(1): e48.
[10] ZINGARELLI E M, GHIGLIONE M, PESCE M, et al. Facial pressure ulcers in COVID-19 50-year-old female intubated patient[J]. Indian J Plast Surg, 2020, 53(1): 144-146.
[11] GIRARD R, BABOI L, AYZAC L, et al. The impact of patient positioning on pressure ulcers in patients with severe ARDS: results from a multicentre randomised controlled trial on prone positioning[J]. Intensive Care Med, 2014, 40(3): 397-403.
[12] 范平, 石俊, 陆杉, 等. 俯卧位通气对急性呼吸窘迫综合征患者预后影响的荟萃分析[J]. 中国急救医学, 2014, 34(4): 302-309.
[13] 周翔, 刘大为, 隆云, 等. 俯卧位通气联合肺复张对重度急性呼吸窘迫综合征患者预后的影响[J]. 中华内科杂志, 2014, 53(6): 437-441.
[14] HOSTE, E. A J. Acute effects of upright position on gas exchange in patients with acute respiratory distress syndrome [J]. J Intensive Care Med, 2005, 20(1): 43-49.
[15] RICHARD J C M, MAGGIORE S M, MANCEBO J, et al. Effects of vertical positioning on gas exchange and lung volumes in acute respiratory distress syndrome[J]. Intensive Care Med, 2006, 32(10): 1623-1626.