不同角度俯卧位对ARDS患者早期氧合及肠内营养耐受性的影响

Effects of prone position at different angles on early oxygenation and enteral nutrition tolerance in ARDS patients

目的比较三种头高足低位角度对ARDS俯卧位通气患者早期氧合及肠内营养耐受性的影响。方法将ICU收治的45例ARDS患者随机分为0°、30°和45°头高足低俯卧位组14例、16例和15例,观察比较俯卧位后5 d内的氧合指数、胃残余量和肠内营养相关并发症发生情况。结果俯卧位5 d后三组氧合指数均有改善,其中0°组与30°组氧合指数显著高于45°组(均P<0.05)。俯卧位第4天,30°组与45°组胃残余量显著少于0°组(均P<0.05)。非0°组反流发生率显著低于0°组(P<0.05)。结论ARDS患者取30°头高足低俯卧位通气可以有效改善氧合,提高喂养耐受性,降低肠内营养并发症发生率。

Objective To compare the effects of three reverse trendelenburg position angles on early oxygenation and enteral nutrition tolerance in ARDS patients receiving prone position ventilation.Methods A total of 45 ARDS patients in ICU were randomized into a 0°,30°,and 45°reverse trendelenburg prone position group,with 14,16 and 15 cases in each group,and the oxygenation index,gastric residual volume and enteral nutrition-related complications were observed and compared for each group during the 5 days with prone position.Results After 5 days in the prone position,the oxygenation index of the three groups were all improved,and the oxygenation index of the 0°group and the 30°group were significantly higher than that of the 45°group(P<0.05 for both).On the 4th day of prone position,the gastric residue volume in the 30°group and the 45°group were significantly less than that in the 0°group(P<0.05 for both).The incidence of reflux in the non-0°group was significantly lower than that in the 0°group(P<0.05).Conclusion The 30°reverse trendelenburg prone position can effectively improve oxygenation,increase the feeding tolerance,and reduce the incidence of enteral nutrition complications for ARDS patients.