腹腔高压患者不同体位监测腹腔压的效果观察

Influences of abdominal pressure monitoring in different positions among abdominal hypertension patients

目的探讨不同体位监测腹腔压力对腹腔高压患者的影响。方法采用便利抽样法,选取2019年1—6月入住东部战区总医院普通外科7 ICU的100例腹腔高压重症患者,通过间接测量膀胱压的方法监测其腹腔压力,测量患者病情平稳时30°卧位、45°卧位和平卧位时的腹腔压力,记录不同体位下患者腹内压的单次测量数据,体位更换后休息15 min进行另一种体位测量。结果100例重症腹腔高压患者在平卧位、30°卧位和45°卧位所测量的腹腔压力分别为(19.18±3.95)、(23.40±3.87)、(28.17±3.60)mmHg(1 mmHg=0.133 kPa),差异有统计学意义(P<0.01)。平卧位所监测的腹腔压力均低于30°卧位和45°卧位所监测的腹腔压力,差异有统计学意义(平卧位vs.30°卧位,P<0.01;平卧位vs.45°卧位,P<0.01);30°卧位和45°卧位所监测的腹腔压力高出平卧位1~2个等级,且不论腹腔高压的重症患者腹腔压力处于何种等级,随着床头抬高角度的增加,腹腔压数值越来越高。结论腹腔高压重症患者不同体位监测腹腔压力存在差异,平卧位监测腹腔压力数据不能作为临床决策的依据,患者实际体位监测腹腔压力更能反映患者真实情况,可为临床护理决策提供一个相对真实可靠的监测数据。

Objective To explore the influences of abdominal pressure monitoring in different positions on patients with abdominal hypertension.Methods From January to June 2019,convenience sampling was used to select 100 critical ill patients with abdominal hypertension who were admitted to the Intensive Care Unit of General Surgery of the General Hospital of Eastern Theater Command as the research object.The abdominal pressure was monitored by indirectly measuring the bladder pressure.We measured the abdominal pressure when patients were in stable condition and in 30°lying position,45°lying position as well as the supine position respectively,recorded the single measurement data of the patient's abdominal pressure in different positions,and performed another position measurement rest for 15 minutes after changing the position.Results The abdominal pressures measured in 100 critical ill patients with abdominal hypertension in the supine position,30°lying position and 45°lying position were(19.18±3.95),(23.40±3.87)and(28.17±3.60)mmHg(1 mmHg=0.133kPa)respectively,and the difference was statistically significant(P<0.01).The abdominal pressure monitored in the supine position was lower than those in the 30°lying position and 45°lying position,the difference was statistically significant(supine position vs.30°lying position,P<0.01;supine position vs.45°lying position,P<0.01).The abdominal pressure monitored in the 30°lying position and 45°lying position was higher than that in the supine position by one to two levels.With the increase of the bed head elevation angle,the abdominal pressure value is getting higher and higher,regardless of the level of abdominal pressure in critical ill patients with abdominal hypertension.Conclusions The abdominal pressure monitoring in actual positions can reflect the true situation of the patient well,and can provide a relatively true and reliable monitoring data for clinical nursing decision-making.