不同角度俯卧位通气对老年呼吸窘迫综合征患者氧合反应及压力性损伤的影响

Effect of prone ventilation at different angles on oxygenation response and pressure injuryin elderly patients with respiratory distress syndrome

目的观察0°俯卧位通气和30°倾斜俯卧位通气对老年呼吸窘迫综合征患者氧合反应及压力性损伤的影响。方法选取2020年2月~2024年2月空军军医大学第一附属医院老年病科收治的拟行俯卧位机械通气的92例老年呼吸窘迫综合征患者。将患者按随机数表法分为0°俯卧位组和30°俯卧位组,每组各46例。比较两组患者第1、2、3、5和7天俯卧位后的平均氧合指数,对两组压力性损伤总发生率及压力性损伤发生部位进行比较。结果剔除脱落病例后,0°俯卧位组44例,30°俯卧位组45例患者完成研究。两组第1、2、3、5和7天俯卧位后氧合指数比较差异无统计学意义(P>0.05)。两组患者28 d病死率差异无统计学意义(P>0.05);第1、2、3、5和7天及入组后平均每日的俯卧位通气时长及通气次数比较差异无统计学意义(P>0.05)。0°俯卧位组共20例患者出现53处压力性损伤,30°俯卧位组11例患者出现25处压力性损伤,两组发生率差异有统计学意义(χ^(2)=4.326,P=0.037)。结论0°和30°俯卧位通气均可改善老年呼吸窘迫综合征患者氧合,30°倾斜俯卧位有利于降低压力性损伤发生率,但对于面部等压力性损伤高发区域仍需采取综合措施重点防护。

Objective To observe the effects of 0°prone position ventilation and 30°inclined prone position ventilation on oxygenation response and pressure injury in elderly patients with respiratory distress syndrome.Methods 92 elderly patients with respiratory distress syndrome who were admitted to the geriatric department from February 2020 to February 2024 and planned to undergo prone mechanical ventilation were studied.Randomly divide patients into a 0°prone position group and a 30°prone position group,with 46 patients in each group.Compare the average oxygenation index of two groups of patients after lying prone on days 1,2,3,5,and 7,and compare the total incidence and location of pressure injury in the two groups.Results After excluding missing medical records,44 patients in the 0°prone position group and 45 patients in the 30°prone position group completed the study.There was no statistically significant difference in oxygenation index between the two groups after lying prone on days 1,2,3,5,and 7.There was no statistically significant difference in the 28 day mortality rate between the two groups,and there was no statistically significant difference in the duration and frequency of prone position ventilation on days 1,2,3,5,7,and the average daily ventilation.A total of 20 patients in the 0°prone position group experienced 53 pressure injuries,while 11 patients in the 30°prone position group experienced 25 pressure injuries.The difference in incidence between the two groups was statistically significant(χ^(2)=4.326,P=0.037).Conclusion Both 0°and 30°prone position ventilation can improve oxygenation in elderly patients with respiratory distress syndrome.30°inclined prone position is beneficial for reducing the incidence of pressure injuries,but comprehensive measures and key protection measures still need to be taken for areas with high incidence of pressure injuries such as the face.