床头抬高角度对呼吸机相关性肺炎发病率的影响

Influence of bedside elevation angle on the incidence of ventilator-associ-ated pneumonia

目的探讨适宜的床头抬高角度对预防呼吸机相关性肺炎(VAP)发生的影响。方法选取2013年1月~2017年12月惠州市第六人民医院收治的150例机械通气患者作为研究对象,按照床头抬高角度的不同,将其分为3组,A组50例患者床头抬高<30°,B组50例患者床头抬高30°~45°,C组50例患者床头抬高>45°。比较不同床头抬高角度下VAP的发生率及不良反应总发生率。观察、分析不同床头抬高角度下三组患者的心率、呼吸频率差异。结果 A组患者的心率和呼吸频率高于B组,差异有统计学意义(t=3.294、2.256,P<0.05);C组患者的心率和呼吸频率高于B组,差异有统计学意义(t=2.887、2.105,P<0.05);A组患者的VAP发生率高于B组,差异有统计学意义(χ~2=7.376,P<0.05),C组患者的VAP发生率高于B组,差异有统计学意义(χ~2=4.882,P<0.05);B、C组患者的不良反应总发生率明显低于A组,差异有统计学意义(P<0.05)。结论床头抬高30°,有利于卧床患者的呼吸,对于留置胃管肠内营养的患者来说,还能够提高胃肠蠕动,减少食物反流,防止误吸发生;对于危重机械通气患者,床头抬高30°,更是预防VAP的重要措施。

Objective To investigate the effect of appropriate bed elevation angle on the prevention of ventilator-associated pneumonia(VAP). Methods A total of 150 patients with mechanical ventilation admitted to Huizhou Sixth People′s Hospital from January 2013 to December 2017 were enrolled. The patients were divided into three groups according to different angles of bed elevation.In group A(n=50), bedside elevation <30°; in group B(n=50), bed elevation was between 30° to 45°; in group C group(n=50), the bed elevation was >45°. The incidence of VAP and total incidence of adverse reactions under different bed elevation angles were compared. The heart rate and respiratory rate of the three groups under different bed elevation angles were observed and analyzed. Results The heart rate and respiratory rate of group A were higher than those of group B(t=3.294 and 2.256; P<0.05). The heart rate and respiratory rate of group C were higher than those of group B with statistical significance(t=2.887 and 2.105; P<0.05). The incidence of VAP in group A was higher than that in group B with a statistical difference(χ~2=7.376; P<0.05). The incidence of VAP in group C was higher than that in group B with a significant difference(χ~2=4.882; P<0.05). The total incidence of adverse reactions in group B and group C was significantly lower compared with that in group A with statistical significance(P<0.05). Conclusion The bed elevation of 30° is beneficial to the breathing of bedridden patients. For patients with indwelling gastric tube for nutrition support, the angle can also enhance gastrointestinal peristalsis, reduce food reflux and prevent aspiration. For patients with critical mechanical ventilation, the angle is an important measure to prevent VAP.