不同体位对老年重症肺炎患者机械通气治疗中氧合作用的影响

Effect of different body positions on oxygenation during mechanical ventilation in elderly patients with severe pneumonia

目的观察不同体位对老年重症肺炎患者氧合作用的影响,探索治疗老年重症肺炎更安全更有效的机械通气方法。方法选取2016年10月-2019年4月在廊坊市人民医院住院行机械通气治疗的老年重症肺炎患者90例,随机分为A组、B组和C组,每组30例。A组患者每天床头抬高30°通气6 h,B组患者每天床头抬高45°通气6 h,A组与B组患者其余时间采用仰卧位通气,C组患者每天均采用仰卧位通气。检测患者呼吸力学指标及血液动力学指标。分别在治疗前与治疗72 h后,评估并比较3组患者动脉血的氧分压(PaO2)、二氧化碳分压(PaCO2)、氧合指数(PaO2/FiO2)、呼吸频率、APACHE-Ⅱ评分、呼吸力学指标(Ppeak、Pmean、Pplat)及血液动力学指标(MAP、CI、ITBVI)。结果3组在机械通气治疗前各指标间的差异无统计学意义(P>0.05)。机械通气治疗72 h后,3组除胸腔内血容量指数外,其余指标均有显著改善(P<0.05);B组的动脉血氧分压和氧合指数显著高于C组(P<0.05),而呼吸频率、动脉血二氧化碳分压和APACHE-Ⅱ评分显著低于C组(P<0.05);A组除氧合指数外,其余指标均显著优于C组(P<0.05),但A组与B组在动脉血氧分压、氧合指数及APACHE-Ⅱ评分方面的差异无统计学意义(P>0.05);B组气道峰压和气道平台压显著低于A组和C组(P<0.05),A组气道峰压也显著低于C组(P<0.05);B组平均气道压显著低于C组(P<0.05),A组平均气道压也显著低于C组(P<0.05)。在心脏指数方面,B组心脏指数显著低于A组和C组(P<0.05)。结论老年重症肺炎患者机械通气治疗时,床头抬高可有效提高治疗效果,当床头抬高45°时治疗效果最好。

Objective To observe the effects of different body positions on oxygenation during mechanical ventilation in elderly patients with severe pneumonia,and to explore safer and more effective mechanical ventilation methods for the treatment of severe pneumonia in the elderly.Methods 90 elderly patients with severe pneumonia who were treated with mechanical ventilation in people’s hospital of Langfang city from October 2016 to April 2019 were randomly divided into group A,group B and group C,with 30 cases in each group.Patients in group A were ventilated with 30°bed elevation every day for 6 hours,ones in group B were ventilated with 45°bed elevation every day for 6 hours,patients in group A and B were ventilated in the supine position for the rest of the time;patients in group C ventilated in the supine position every day.Before treatment and72 hours after treatment,the arterial partial pressure of oxygen(PaO2),arterial partial pressure of carbon dioxide(PaCO2),oxygenation index(PaO2/FiO2),respiratory frequency,APACHE-Ⅱscore,respiratory mechanics indexes(Ppeak,Pmean,Pplat)and hemodynamic indexes(MAP,CI,ITBVI)were evaluated and compared among the three groups.Results There was no statistically significant difference among the three groups before mechanical ventilation treatment(P>0.05).After72 hours of mechanical ventilation treatment,except for the intrathoracic blood volume index,the other indexes of the three groups were significantly improved(P<0.05).PaO2 and oxygenation index of group B were significantly higher than those of group C(P<0.05),while respiratory frequency,PaCO2 and APACHE-Ⅱscore were significantly lower than those of group C(P<0.05).Except for the oxygenation index,the other indexes of group A were significantly better than those of group C(P<0.05),but there was no statistically significant difference in PaO2,oxygenation index and APACHE-Ⅱscore between group A and group B(P>0.05).The Ppeak and Pplat of group B were significantly lower than those of groups A and C(P<0.05),and the Ppeak of group A was significantly lower than that of group C;The Pmean of group B were significantly lower than that of groups A and C(P<0.05),and the Pmean of group A was significantly lower than that of group C.The cardiac index of group B was significantly lower than that of group A and group C(P<0.05).Conclusion In the treatment of elderly patients with severe pneumonia,bed head elevation can effectively improve the treatment effect,and the treatment effect is the best when the bed head is raised by 45°.