床头角度对插管机械通气患者呼吸机相关性肺炎发病率的影响

Decreasing the risk of ventilator-associated pneumonia through head of bed elevation

目的探讨病床不同床头角度对呼吸机相关性肺炎(VAP)发病率的影响。方法将气管插管机械通气患者随机分为平卧、床头25°、床头45°等3组,观察不同床头角度下患者VAP的发病率。结果平卧组患者VAP发病率及病死率最高,床头25°组次之,45°组最低,差异有统计学意义。结论抬高床头角度可降低机械通气患者VAP的发病率。

Objective Ventilator- associated pneumonia （VAP） occurs in a high percentage （5%-25%） of ventilated patients. Placing critically ill ventilated patients in a semirecumbent position may minimize the likelihood of nosocomial pneumonia. This study explores the effects of body on the incidence of VAP in intubation patients. Methods The design was quantitative in nature, using a randomized controlled trial. The method involved adult ventilated patients being randomly assigned to one of three positions, i. e. 45° raised head of bed （45° group） or 25° raised head of bed （25° group） or recumbent position （control group）. Data collection relied upon the diagnosis of clinically suspected and microbiologically confirmed pneumonia defined by the Consensus Conference on VAP. Results One hundrend and Thirteen patients were included in the study,23 in the 45° group and 24 in the 25° group and 20 in the control group. Results showed that 24% （five） in the 45° group and 51% （seven） in the 25° group and 67% in control group contracted VAP （P〈0.05）. Conclusions Bed head elevation may reduce the VAP incidence in mechanically ventilated patients.