床头抬高角度对机械通气患者胃食管反流与压疮的影响

The effects of upper body raising position on gastric reflux and pressure ulcer in mechanical ventilation patients

目的探讨不同床头抬高角度对机械通气患者胃食管反流与压疮发生的影响。方法选择需有创机械通气和肠内营养的90例非胃食管反流病(gastric reflux disease,GERD)患者为研究对象,随机分为3组,床头抬高30°组(A组,29例)、35°组(B组,28例)和40°组(C组,33例),研究时间为7 d,每天按计划时间点测3组患者床头抬高角度、口腔pH值、口腔分泌物中的胃蛋白酶、胃潴留量及压疮Braden评分,比较3组研究对象白天与夜间胃蛋白酶阳性率、口腔pH值合格率、胃潴留发生率、首末次Braden评分差值比较及床头抬高达标率。结果 3组研究对象白天与夜间胃蛋白酶阳性率、口腔pH值合格率、胃潴留发生率差异均无统计学意义(P>0.05);与A组比,B、C两组首末次Braden评分差值增大,差异有统计学意义(P<0.01),且C组的差值更大(P<0.01);与A组比,B、C两组白天与夜间床头抬高达标率降低,差异有统计学意义(P<0.01),且C组的达标率更低(P<0.01)。结论相比于床头抬高35°和40°,抬高30°既能有效预防机械通气合并肠内营养患者胃食管反流的发生,又不增加发生压疮的风险。

Objective To investigate the effects of upper body raising position on gastroesophageal reflux and pressure ulcer in mechanical ventilation patients. Methods Ninety patients without gastroesophageal reflux disease(GERD), who required invasive mechanical ventilation and enteral nutrition, were selected and randomly divided into 3 groups. The head of bed was elevated by 30°(Group A, 29 cases), 35°(Group B, 28 cases) and 40°(Group C, 33 cases), respectively, in the 3 groups. The study was conducted for 7 days. The oral PH value, pepsin in oral secretions, gastric retention, and Braden score for pressure ulcers were assessed and compared. Results There were no significant difference in daytime or nocturnal pepsin positive rate, oral PH value or gastric retention among the 3 groups(P>0.05). Compared with Group A, the differences between the first and last Braden scores in Group B and C were significantly increased(P<0.01), which was significantly more prominent in Group C(P<0.01). Compared with Group A, the daytime and nighttime bed lifts in Group B and C were significantly lower(P<0.01), among which the compliance rate in Group C was significantly the lowest(P<0.01).Conclusion The upper body raising by 30° can effectively prevent the GERD in patients with mechanical ventilation and enteral nutrition without increasing the risk of pressure ulcers.