半坐卧位预防呼吸机相关性肺炎

    的临床实验研究

    X

    柳 韦 华1

    ,王 凤2

    ,吕 梅3

    ,姚梅芳4

    (11 泰山医学院,山东 泰安 271000 ; 21 泰安市中心医院,山东 泰安 271000

    31 莱芜市医院,山东 莱芜 271100 ;41上海长海医院,上海 200000)

    摘要:目的 确定 RICU 机械通气病人半坐卧位可减少误吸。方法 对20 例 RICU 机械通气病人随机取水平

    仰卧位或半坐卧位 ,间隔 2 天交换 2 种体位做自我对照实验 ,用 Tc299 m硫胶体标记病人胃内容物 ,5 h 内每隔 30

    min测定气管、 支气管内分泌物的放射计数。结果 病人在仰卧位和半坐卧位护理时 ,支气管内分泌物 5h 的总放

    射计数均数分别是 4169 ±1957 cpm和972 ±211 cpm ( P < 0105) ;仰卧位30 min和300 min的放射计数分别是301

    ±153 cpm和 2601 ±1904 cpm ( P < 0105) ;半坐卧位 30 min和 300 min的放射计数分别是 110 ±44 cpm和 217 ±

    61 cpm ( P < 0105) 。病人胃液、 咽拭子和支气管内分泌同种细菌检出率 ,半坐卧位为 35 % ,仰卧位达 70 %。结论

    RICU 病人持续水平仰卧位护理是胃内容物返流后误吸入气道的潜在高危因素。

    关键词:机械通气;半坐卧位;呼吸机相关性肺炎

    中图分类号:R473. 5 文献标识码:A 文章编号:100427115 (2003) 0220142203

    Study of the semirecumbent position prevention of ventilator2 associated pneumonia

    L IU Wei , WA N G Fei , L U Mei , YAO Mei2f ang

    ( Taishan Medical College , Taian 271000 ,China)

    Abstract : Objective : To determine whether the semirecumbent position (452degree angle ) decreases aspiration of

    gast ric contents to the airways in intubated and mechanically ventilated patients1 Methods : Twenty patients requiring in2

    tubation and mechanical ventilation in res piratory intensive care unit were given a randomized , two - period crossover t ri2

    al1 The patients were studied in the su pine and semirecumbent positions in two separate days1 After technetium( Tc)299 m

    sulphur colloid labeling of gast ric contents , sequential radioactive counts in endobronchial secretions were measured at 30 2

    minute intervals over a 5 2hour period1 Results :Mean radioactive counts in endobronchial secretions in sam ples obtained

    when patients were in the supine position were higher than those in the semirecumbent position (4169 ±1957 cpm and

    972 ±211 cpm; P < 0105) ; Moreover , the as piration pat tern for each position was time 2dependent : for the supine posi2

    tion , radioactivity was 301±153 cpm at 30 min and 2601±1904 cpm at 300 min ( P < 0105) ; for the semirecumbent

    position , radioactivity was 110±44 cpm at 30 min and 217±61 cpm at 300 min ( P < 0105) 1 The same microorganisms

    were isolated f rom stomach , pharynx , and endobronchial samples in 35 % of studies done while patients were semirecum2

    bent but in 70 %of studies done while patients were in the supine position1 Conclusion : The supine position and the length

    of time in this position are potential risk factors for as piration of gast ric contents1

    Key words : mechanical ventilation ; semirecumbent position ;ventilator2associated pneumonia

    将床头抬高预防误吸是降低呼吸机相关性肺炎

    (Ventilator2associated pneumonia , VAP)发病率的重

    要预防措施 ,而且美国疾病控制中心(CDC)规定 ,为

    了预防 VAP将病人床头抬高 30° ～45° [ 1 ];但在临床

    护理工作中 ,由于 ICU 患者病情较重经常采取水平

    仰卧位 ......