体位交替管理方案预防ICU患者机械通气相关并发症的临床效果

Clinical Effects of Postural Alternation Management Scheme in Preventing Complications Related to Mechanical Ventilation in ICU Patients

目的探究体位交替管理方案预防ICU患者机械通气相关并发症的临床效果。方法选取2019年5月至2021年5月于医院ICU行机械通气的90例患者,采取随机数字表法分为两组,各45例,排除中途退出研究、转院、死亡或者临床资料不完整者,共84例患者进入最后研究,其中对照组43例,观察组41例。对照组给予常规护理,观察组在对照组基础上给予体位交替管理方案,比较两组机械通气5 d内痰液引流量、胸片改善时间、机械通气时间、机械通气相关并发症发生率及患者对机械通气的依从性。结果与对照组比较,观察组机械通气5 d内口鼻腔、气管导管内引流量均较多,胸片改善时间及机械通气时间均较短,机械通气相关并发症发生率较低,差异均有统计学意义(P<0.05);同时,观察组对无创机械通气、每日行自然觉醒试验、按需更换呼吸回路、声门下分泌物引流、氯己定口腔护理的依从性均高于对照组,差异有统计学意义(P<0.05)。结论体位交替管理方案应用于ICU机械通气患者中,能更好地促进痰液引流,缩短胸片改善时间及机械通气时间,降低机械通气相关并发症发生率,并可提高患者对ICU机械通气各项操作的依从性。

Objective The clinical effects of postural alteration management scheme in preventing complications related to mechanical ventilation in ICU patients were explored.Methods 90 patients who received mechanical ventilation in ICU in the hospital from May 2019 to May 2021 were selected and they were divided into two groups according to the random number table method,with 45 cases in each group.A total of 84 patients enrolled the study finally except for those who withdrew from the study halfway,transferred to the other hospital,died or had incomplete clinical data,with 43 cases included in the control group and 41 cases included in the observation group.The control group was given routine interventions,on this basis,the observation group was given postural alteration management scheme,the sputum drainage volume,the chest radiograph improvement time,the mechanical ventilation time,the incidence of complications related to mechanical ventilation and the patient's compliance with mechanical ventilation within 5 days after treated by mechanical ventilation were compared between the two groups.Results Compared with the control group,the observation group had more oral and nasal drainage volume and endotracheal drainage volume,shorter chest radiograph improvement time and mechanical ventilation time and lower incidence of complications related to mechanical ventilation within 5 days after treated by mechanical ventilation,with statistically significant differences(P<0.05);meanwhile,compared with the control group,the observation group had higher compliance with non-invasive mechanical ventilation,daily natural awakening test,replacement of breathing circuit as needed,drainage of subglottic secretions,and oral care by chlorhexidine,and the differences were statistically significant(P<0.05).Conclusion The application of postural alteration management scheme to patients treated by mechanical ventilation in ICU can better promote sputum drainage,shorten the chest radiograph improvement time and mechanical ventilation time,reduce the incidence of complications related to mechanical ventilation,and improve patients'compliance with various operations of mechanical ventilation in ICU.