俯卧位机械通气在急性呼吸窘迫综合征中的应用及护理对策

Application of prone position ventilation in acute respiratory distress syndrome and its nursing countermeasures

目的探讨俯卧位机械通气在急性呼吸窘迫综合征(ARDS)中的应用效果,并总结其有效护理措施。方法选择茂名市人民医院外科ICU于2016年1月至2017年10月期间收治的34例ARDS患者为研究对象,根据随机数表法分为对照组和观察组,每组17例,对照组患者予常规仰卧位机械通气治疗,观察组患者则间断应用俯卧位机械通气,比较两组患者治疗后不同时间的平均动脉压(MBP)、心率(HR)以及氧饱和度(SpO_2)、氧合指数(PaO_2/FiO_2)的变化。结果通气2 h及通气24 h,两组患者的MAP、HR比较差异均无统计学意义(P>0.05);而观察组患者的SpO_2、PaO_2/FiO_2分别为(90.5±4.5)%和(231.5±19.8)、(95.3±3.9)%和(248.1±21.4),均明显高于对照组的(84.2±4.1)%和(185.6±17.1)、(91.4±4.7)%和(207.2±15.8),差异均有统计学意义(P<0.05)。结论俯卧位机械通气能有效改善ARDS患者的氧合状况,且不影响血流动力学的稳定;采取有效的护理措施,可防范并发症的发生,以确保通气的顺利实施。

Objective To investigate the application effect of prone position ventilation in acute respiratory distress syndrome（ARDS）, and summarize the effective nursing measures. Methods A total of 34 cases of ARDS patients, who admitted to Department of Surgical ICU of Maoming People＇s Hospital from January 2016 to October 2017,were selected and divided into the observation group and the control group according to random number table, with 17 cases in each group. The control group received routine supine mechanical ventilation, and the observation group was treated with intermittent prone position ventilation. The changes of mean arterial pressure（MBP）, heart rate（HR）, oxygen saturation（SpO2） and the ratio of the arterial partial pressure of oxygen to the fraction of inspired oxygen（PaO2/FiO2） at different times after treatment were compared between the two groups of patients. Results At 2 h and 24 h,there was no significant difference in MAP and HR between the two groups（P〈0.05）. SpO2 and PaO2/FiO2 in the observation group were respectively（90.5±4.5）% and（231.5±19.8）,（95.3±3.9）% and（248.1±21.4）, which were significantly higher than corresponding（84.2±4.1）% and（185.6±17.1）,（91.4±4.7）% and（207.2±15.8） in the control group（P〈0.05）.Conclusion Prone position ventilation can effectively improve the oxygenation status of patients with ARDS, and does not affect hemodynamic stability. Effective nursing measures can prevent the complications and ensure the smooth implementation of ventilation.