改良式侧卧位角度对高龄重症肺炎患者肺功能的影响

Effect of improved lateral decubitus angle on lung function in elderly patients with severe pneumonia

目的探讨改良式侧卧位角度对高龄重症肺炎患者肺功能的影响。方法选择2019年4月—2022年4月苏州市立医院东区重症医学科收治的70例患者为研究对象,按照组间资料均衡可比的原则分为观察组与对照组,每组35例。对照组予以常规侧卧位角度(左侧30°—半坐卧/床头抬高30°—右侧30°卧位),观察组予以改良式侧卧位角度(左侧45°—半坐卧/床头抬高30°—右侧45°卧位),对比两组患者干预前后肺功能、不同时点24 h痰液量、住院指标及预后等指标。结果两组患者上机前、上机2 h、上机6 h 3个时点的BR、PaO_(2)比较组间、不同时间点、组间与时间交互作用差异均有统计学意义(P<0.05),上机2 h、上机6 h时,BR指标观察组均低于对照组,PaO_(2)指标观察组高于对照组,差异均有统计学意义(P<0.05)。两组患者第1、3、5天3个时点的24 h痰液量比较组间、不同时间点、组间与时间交互作用差异均有统计学意义(P<0.05),第3、5天时24 h痰液量观察组均高于对照组,差异有统计学意义(P<0.05)。观察组机械通气时间、住院时间短于对照组,急性生理与慢性健康评分(APACHEⅡ)低于对照组,卡氏评分(KPS)高于对照组,差异均有统计学意义(P<0.05)。结论改良式侧卧位角度能有效改善高龄重症肺炎患者呼吸功能,促进24 h痰液量,改善预后效果。

Objective To explore the impact of modified lateral decubitus angles on lung function in elderly patients with severe pneumonia.Methods A total of 70 patients admitted to the east district critical care department of Suzhou Municipal Hospital from April 2019 to April 2022 were selected as the study subjects.They were divided into an observation group and a control group based on the principle of balanced and comparable data between groups,with 35 patients in each group.The control group was placed in a conventional lateral position(left side 30°-semi sitting/bed head raised 30°-right side 30°),while the observation group was placed in a modified lateral position(left side 45°-semi sitting/bed head raised 30°-right side 45°).The lung function,24-hour sputum volume at different time points,hospitalization indicators,and prognosis of the two groups of patients were compared before and after intervention.Results There were statistically significant differences in the comparison of BR and PaO_(2) between groups,different time points,interaction between groups and time in patients of the two groups at three time points,such as before use breathing machine,2 hours of use breathing machine,and 6 hours of use breathing machine(P<0.05).After 2 and 6 hours of operation,the BR of the observation group was lower than that of the control group,and PaO_(2) was higher than that of the control group,the differences were statistically significant(P<0.05).The 24-hour sputum volume of two groups of patients at three time points on the first,third,and fifth day was compared,and there were statistically significant differences between groups,at different time points,interaction between groups and time(P<0.05).On the 3rd and 5th days,the 24-hour sputum volume in the observation group was higher than that in the control group,the difference was statistically significant(P<0.05).The mechanical ventilation time and hospital stay of the observation group were shorter than those of the control group,the acute physiology and chronic health evaluation scoring system(APACHEⅡ)score was lower than that of the control group,and KPS was higher than that of the control group,the differences were statistically significant(P<0.05).Conclusion The improved lateral decubitus angle can effectively improve the respiratory function of elderly patients with severe pneumonia,improve 24-hour sputum volume,and improve the prognosis.