积极干预床头抬高对VAP发生的影响

Effects of actively intervention in head-of-bed elevation to reduce ventilator-associ-ated pneumonia

目的：观察不干预床头抬高角度与积极干预保持床头抬高角度在30-45。的VAP发生率。方法选取2012年10月至2013年3月ICU中MV超过48 h患者305例不干预床头抬高角度作为对照组，选取2013年4月至2013年9月ICU中MV超过48 h患者328例积极干预下保持床头抬高角度在30-45。作为试验组，使用量角器进行床头抬高角度测量。每位患者均记录年龄、APACHEⅡ、性别、抗生素使用、溃疡药使用、住院时间、MV时间，患者拔管、出科或死亡等研究终止指标，最后计算VAP发生率。结果对照组未干预抬高角度实测平均是（21.5±6.52）度，低于目测目标角度30°，床头抬高角度值被明显高估，试验组经积极干预后抬高角度平均为（36.8±4.31）度。在基线特征中，两组间差异无统计学意义（P〉0.05）。对照组VAP发生率为38.36%，试验组VAP发生率为25%，两组间差异有统计学意义（ P〈0.05）。结论如不进行积极干预，床头抬高角度较难达到并保持在30-45°，积极干预保持床头抬高角度在30-45°可以有效降低MV患者VAP发生率，提高患者生存率。

Objective To observe the non-intervention of the measured head elevation angle and with the active intervention of the head elevation maintained at 30. -45.incidence of ventilator-associated pneumonia （ VAP ） . Methods From October 2012 to March 2013 mechanical ventilation （ MV） more than 48 hours in ICU 305 cases of non-intervention in the bed elevation angle were selected into the control group. From April 2013 to September 2013 MV more than 48 hours in ICU 328 cases of active intervention to maintain head elevation angle of 30.-45.were selected into the experimental group, using a protractor for head elevation angle measurements. Ages, APACHE Ⅱ, gender, use of antibiotics, ulcer drug use, hospitalization time, MV time to extubation, death or study termination departmental rotation indicator, the final calculation of the incidence of VAP were measured and compared . Results Average elevation angle measured of control group without intervention was （21. 5±6. 52）., Which was lower than target angle to vis-ual angle of 30., head elevation angle value was overestimated, averaged angle of the experimental group after active in-tervention elevation was （36. 8±4. 31）.. In baseline characteristics, the difference between the two groups was not statistically significant （ P〉 0. 05 ） . VAP in the control group was 38. 36% , VAP in the experimental group was 25%, the difference between the two groups was statistically significant （ P〈0. 05 ） . Conclusion Without active intervention, head-of-bed elevation angle is more difficult to achieve and maintain at 30. -45., the active intervention to keep head-of-bed elevation angle of 30. -45. can reduce the incidence of MV patients with VAP, improve patient survival.