半坐侧卧位在预防呼吸机相关性肺炎中的应用

Application of semirecUning and alternately lateral recumbent body position on prevention of ventilator associated pneumonia

目的探讨ICU机械通气患者通过半坐侧卧位减少误吸和有效的体位引流在预防呼吸机相关性肺炎(VAP)中的作用。方法对55例ICU机械通气患者随机分成两组:试验组28例,对照组27例。试验组给予半坐侧卧位(10°～45°),每2 h更换侧卧位(45°～60°),而对照组则给予定时10°～45°半坐卧位,两组均行常规胸部物理治疗。定期行下呼吸道获取细菌学标本行病原学检查。结果两组之间性别、年龄、急性生理和慢性健康评分系统(APACHEⅡ)评分、VAP危险因素方面等一般临床资料差异无统计学意义。试验组VAP发生率为21.4%(6例),对照组VAP发生率为40.7%(11例)。VAP的发生率、机械通气时间及ICU留置时间试验组明显优于对照组,差异有统计学意义(P<0.05)。而住院时间及病死率两组间差异无统计学意义(P>0.05)。结论半坐侧卧位更有利于减少误吸和体位引流,从而减少机械通气患者VAP的发生,缩短机械通气时间及ICU留置时间。

Objective To evaluate preventive effect of semireclining and alternately lateral recumbent position on ventilator associated pneumonia. Method Fifty-fiv patients requiring mechanical ventilation for more than 48 hours were randomly divided into two groups 28 in semirechning with alternately lateral recumbent position group and 27 in only semirechning group. Chest physiotherapy was carried out simultaneously in two groups. The secretion in lower respiratory tract was regularly collected for quantitative cultures of microbiology. Results There were no significant differences between groups on gender, age, Acute Physiology and Chronic Health Evaluation Ⅱ score, risk factors for VAP. VAP occurred in 6 of 28 patients in the semireclining and alternately lateral recumbent position group and in 11 of 27 in the semireclining group （ P 〈 0.05）. There was statistically significant difference on VAP rate, ventilator days and ICU time between the groups （ P 〈 0.05）. There was no difference in hospital stay and mortality rate between the groups （ P 〉 0.05）. Condusions Semi-reclining with alternately lateral recumbent position can reduce aspiration and postural drainage that can decrease VAP rate and shorten duration of mechanical ventilation and ICU stay.