高侧卧位在ICU机械通气并发肺部感染病人中的应用研究

Application value of high lateral decubitus position in patients with mechanical ventilation complicated with pulmonary infection in ICU

目的:探讨高侧卧位对ICU机械通气并发肺部感染病人的临床应用效果。方法:选择ICU机械通气并发肺部感染病人80例为研究对象,应用前瞻性对照研究方法,随机数字表法将病人分为对照组和观察组,各40例,对照组病人采用30°~45°低侧卧位,观察组病人采用80°~135°高侧卧位。比较2组病人的感染改善情况、肺通气状况、治疗结局及并发症发生率有无差异。结果:2组病人在性别、年龄、基础疾病、急性生理学与慢性健康状况评分Ⅱ、氧合指数(PaO_(2)/FiO_(2))、体质量指数、平均动脉压、心率、呼吸频率等一般情况比较差异均无统计学意义(P>0.05)。干预后第1天、第3天,2组病人的体温、降钙素原(PCT)及白细胞计数差异无统计学意义(P>0.05),干预后第5天观察组病人体温及PCT值明显低于对照组(P<0.01)。干预后第1天、第3天、第5天观察组病人二氧化碳分压值均低于对照组(P<0.01),干预后第3天及第5天观察组病人氧分压、PaO_(2)/FiO_(2)值均高于对照组(P<0.01)。观察组病人机械通气时间、气管插管时间、置ICU住院时间及住院总时间均较对照组缩短(P<0.05~P<0.01),2组病人28 d病死率差异无统计学意义(P>0.05),2组病人压力性损伤、误吸、脱管及呼吸机相关性肺炎等并发症发生率差异无统计学意义(P>0.05)。结论:80°~135°高侧卧位可提高ICU机械通气并发肺部感染病人的通气功能,降低炎性反应,改善治疗结局,不增加并发症发生率,值得临床应用并推广。

Objective:To investigate the clinical aplication effects of high lateral decubitus position in the patients with mechanical ventilation complicated with pulmonary infection in ICU.Methods:A total of 80 patients with mechanical ventilation complicated with pulmonary infection in ICU were selected as the study objects.A prospective control study was applied,and the patients were divided into the control group and observation group by random number table method(40 cases each group).The low lateral decubitus position of 30°to 45°and high lateral decubitus position of 80°to 135°were applied in the control group and observation group,respectively.The improvement of infection,pulmonary ventilation status,treatment outcome and complication rate were compared between two groups.Results:There was no statistical significance in the gender,age,underlying diseases,acute physiology and chronic health status scoreⅡ,oxygenation index(PaO_(2)/FiO_(2)),body mass index,mean arterial pressure,heart rate and respiration between two groups(P>0.05).There was no statistical significance in the body temperature,procalcitonin(PCT)and white blood cell count between two groups after 1 and 3 days of intervention(P>0.05),but the body temperature and PCT in the observation group were significantly lower than those in control group after 5 days of intervention(P<0.01).After 1 d,3 d and 5 d of intervention,the partial pressure of carbon dioxide values in the observation groups were lower than those in control group(P<0.01),and the partial pressure of oxygen and PaO_(2)/FiO_(2) values in the observation group after 3 d and 5 d of intervention were higher than those in control group(P<0.01).The mechanical ventilation time,tracheal intubation time,ICU stay time and total hospital stay in the observation group were shorter than those in control group(P<0.05 to P<0.01),and there was no statistical significance in the 28-day mortality between two groups(P>0.05).There was no statistical significance in the incidence rates of pressure injury,aspiration,catheterization and ventilator-associated pneumonia between two groups(P>0.05).Conclusions:The 80°to 135°high lateral decubation can improve the ventilation function of ICU patients with mechanical ventilation complicated with pulmonary infection,reduce inflammatory response,improve treatment outcome,and do not increase the incidence of complications,which is worthy of clinical application and promotion.