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    急性呼吸窘迫综合征病人不同俯卧位护理策略的效果评价

    Application effects of different prone positions nursing strategies in patients with acute respiratory distress syndrome

      摘要
    • 摘要:
      目的探讨改良式与传统俯卧位护理策略在急性呼吸窘迫综合征（ARDS）病人中的应用效果。
      方法选择2017年6月至2019年5月行俯卧位通气治疗的ARDS病人47例，对照组（27例）采用头胸部垫俯卧位枕抬高的传统俯卧位护理方式；观察组（20例）病人采用基于力学分布的改良俯卧位护理策略。比较2组病人并发症（压力性损伤、呕吐）的发生情况、俯卧位前后血流动力学心率（HR）、平均动脉压（MAP）、中心静脉压（CVP））的变化及呼吸力学气道阻力（R）、胸肺顺应性（Cst）的变化。
      结果观察组压力性损伤发生率低于对照组（P < 0.05）。2组病人呕吐和意外脱管发生率差异无统计学意义（P>0.05）。2组病人在俯卧位前和俯卧位1 h、2 h、4 h的HR、CVP比较差异均无统计学意义（P>0.05）；观察组病人在俯卧位前的MAP高于对照组（P < 0.05），2组在俯卧位1 h、2 h、4 h的MAP比较差异均无统计学意义（P>0.05）。观察组病人在俯卧位前和俯卧位1h的R高于对照组（P < 0.05和P < 0.01），而在俯卧位2 h和4 h比较，2组R差异无统计学意义（P>0.05）。2组病人在俯卧位前、俯卧位1 h、2 h、4 h的Cst比较，差异均无统计学意义（P>0.05）。
      结论改良式俯卧位通气护理策略较传统俯卧位方式可降低ARDS病人并发症发生率，值得在临床推广。

       

      Abstract:
      ObjectiveTo explore the application effects of improved and traditional prone position nursing strategies in patients with acute respiratory distress syndrome(ARDS).
      MethodsFrom June 2017 to May 2019, 47 ARDS patients with prone position were divided into the control group(27 cases) and observation group(20 cases).The control group and observation group were nursed with traditional prone position(head and chest pad prone position and pillow elevation) and improved prone position nursing strategy based on mechanical distribution, respectively.The occurrence of complications(pressure injury and vomiting), changes of hemodynamicsheart rate(HR), mean arterial pressure(MAP) and central venous pressure(CVP) and changes of respiratory mechanicsairway resistance(R), chest and lung compliance(Cst) before and after prone position were compared between two groups.
      ResultsThe incidence rate of stress injury in observation group was lower than that in control group(P < 0.05).There was no statistical significance in the incidence of vomiting and accidental detubation between two groups(P>0.05).The differences of the HR and CVP between two groups were not statistically significant before prone position and after 1h, 2h and 4h of prone position(P>0.05).The MAP in observation group before prone position was higher than that in control group(P < 0.05), and the differences of MAP between two groups were not statistically significant after 1h, 2h and 4h of prone position(P>0.05).The R in observation group before and after 1 h of prone position were higher than that in control group(P < 0.05 and P < 0.01), while there was no statistical significance in R between two groups after 2 h and 4 h of prone position(P>0.05).The differences of the Cst between two groups were not statistically significant before and after 1h, 2h and 4h of prone position(P>0.05).
      ConclusionsCompared with the traditional prone position nursing strategy, the improved prone position ventilation nursing strategy can reduce the incidence of complications in ARDS patients, which is worthy of clinical promotion.

       

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