床头抬高20°~25°对重症哮喘合并呼吸衰竭机械通气患者的影响

The Effects of Raising the Head of the Bed by 20°-25°in Patients with Severe Asthma and Mechanical Ventilation with Respiratory Failure

目的探讨床头抬高20°~25°对重症哮喘合并呼吸衰竭机械通气患者的影响。方法选取2018年1月至2020年7月许昌市人民医院收治的92例重症哮喘合并呼吸衰竭机械通气患者作为研究对象,根据收治时间分为对照组(2018年1月至2019年3月)与观察组(2019年4月至2020年7月),各46例。对照组床头抬高30°~45°,观察组床头抬高20°~25°。比较两组机械通气时间、重症加强护理病房(ICU)入住时间、呼吸机相关性肺炎(VAP)及压力性损伤发生率、各时间点骶尾部温度以及平均动脉压(MAP)。结果两组机械通气时间比较,差异有统计学意义(P<0.05);观察组ICU入住时间短于对照组,差异有统计学意义(P<0.05)。观察组VAP发生率(10.87%)低于对照组(13.04%),差异无统计学意义(P>0.05);观察组压力性损伤发生率(2.17%)低于对照组(6.52%),差异无统计学意义(P>0.05),且压力性损伤均为Ⅰ期。两组不同时间点MAP比较,差异无统计学意义(P<0.05);两组床头抬高时骶尾部温度比较,差异无统计学意义(P>0.05);抬高后30 min、1 h、90 min、2 h,观察组骶尾部温度低于对照组,差异有统计学意义(P<0.05)。结论床头抬高20°~25°有助于促进重症哮喘合并呼吸衰竭机械通气患者的康复进程,减少VAP及压力性损伤的发生,降低骨突处温度,且不会对骨突处血运造成不良影响。

Objective To explore the effect of raising the head of the bed 20°-25°in patients with severe asthma and mechanical ventilation with respiratory failure.Methods A total of 92 patients with severe asthma combined with respiratory failure and mechanical ventilation who were admitted to Xuchang People’s Hospital from January 2018 to July 2020 were selected as the research objects.The patients who were selected from January 2018 to March 2019 were control group,the patients who were selected from April 2019 to July 2020 were observation group.The head of the bed of the control group was raised by 30°-45°,the head of the bed of the observation group was raised by 20°-25°.The mechanical ventilation time,intensive care unit(ICU)stay time,incidence of ventilator associated pneumonia(VAP)and pressure injury,sacral temperature at each time point,and mean arterial pressure(MAP)changes were compared between the two groups.Results There was no statistically significant difference in the mechanical ventilation time between the two groups(P>0.05).The ICU stay time of the observation group was shorter than that of the control group(P<0.05).The incidence of VAP in the observation group(10.87%)was was lower than that of the control group(13.04%)(P>0.05).The incidence of stress injury of the observation group(2.17%)was lower than that of the control group(6.52%)(P>0.05),and the pressure injuries were all stage I.After raising 30 min,1 h,90 min and 2 h,the sacral temperature of the observation group were lower than those of the control group(P<0.05).Conclusion Raising the head of the bed by 20°-25°can help accelerate the rehabilitation process of patients with severe asthma complicated by mechanical ventilation with respiratory failure,reduce the risk of VAP and pressure injury,and will not harm the skin temperature and blood pressure at the bony process cause adverse effects.