俯卧位通气在急性呼吸窘迫综合征治疗中的应用效果

Application effect of prone position ventilation in the treatment of acute respiratory distress syndrome

目的 探讨俯卧位通气用于急性呼吸窘迫综合征患者的临床效果及护理体会.方法 选取临汾市第四人民医院2015年6月至2017年6月收治的急性呼吸窘迫综合征患者60例为研究对象,根据患者通气方法不同分为对照组和观察组,每组30例.对照组采用仰卧位机械通气治疗,观察组采用俯卧位通气治疗.对比两组临床疗效.结果 观察组上机时间、住院时间分别为（13.72±2.14）d、（21.96±4.35）d,均显著短于对照组的（18.63±3.12）d、（35.21±5.27）d,差异均有统计学意义（t=7.11、10.62,均P〈0.05）;观察组不良反应发生率为3.33％（1/30）,明显低于对照组的16.67％（8/30）,差异有统计学意义（χ2=6.41,P〈0.05）.两组治疗前二氧化碳分压、pH、氧合指数差异均无统计学意义（t=0.28、0.13、1.94,均P〉0.05）;治疗后,对照组pH无明显变化（P〉0.05）,两组其余指标均显著改善（均P〈0.05）,但观察组改善效果显著优于对照组,差异均有统计学意义（t=8.55、19.25、3.46,均P〈0.05）.结论 急性呼吸窘迫综合征患者采用俯卧位通气治疗的临床疗效显著,可以有效的改善患者的血氧指标,且不良反应轻微,具有较高的临床推广价值.

Objective To explore the clinical effect and nursing experience of prone position ventilation for patients with acute respiratory distress syndrome（ARDS）. Methods From June 2015 to June 2017,60 patients with ARDS in the Fourth People＇s Hospital of Linfen were selected and divided into observation group and control group according to different ventilation methods,with 30 cases in each group. The control group was treated with supine mechanical ventilation,the observation group was treated with prone position ventilation. The clinical efficacy of the two groups was compared. Results The mean duration of on - boarding and hospital stay in the observation group were （13. 72 ± 2. 14）d and （21. 96 ± 4. 35）d,respectively,which were significantly shorter than those in the control group[（18. 63 ± 3. 12）d,（35. 21 ± 5. 27）d],the differences were statistically significant（t = 7. 11,10. 62,all P 〈0. 05）. The incidence rate of adverse reactions in the observation group was 3. 33％ （1 / 30）,which was significantly lower than 16. 67％ （8 / 30） in the control group,the difference was statistically significant（χ2 = 6. 41,P 0. 05）. After 12 hours of treatment,the pH in the control group had no change（P 〉0. 05）,the other indicators in the two groups were significantly improved（all P 〈 0. 05）,and the improvement effect in the observation group was significantly better than those in the control group（t = 8. 55,19. 25,3. 46,all P 〈 0. 05）. Conclusion Prone position ventilation in the treatment of patients with ARDS has significant clinical efficacy,can effectively improve the patients＇ blood oxygen indicators,and has mild adverse reactions with a high clinical value.