刘芳印等

【摘要】目的研究分时段不同床头高度对ICU患者呼吸机相关性肺炎（VAP）的影响。方法将2014年1～12月行有创机械通气的364例患者随机分为实验组和对照组各182例。两组患者均按照预防VAP措施进行常规护理，实验组患者床头高度分日夜时段分别为30°～45°和20°～30°，对照组患者床头高度24小时保持在30°～45°。对两组患者的VAP感染率、压疮发生率及舒适度情况进行比较。结果实验组VAP感染率和压疮发生率显著低于对照组（P<0.05），舒适度优于对照组（P<0.01）。结论分时段抬升床头不同的高度，不仅能有效预防ICU机械通气患者VAP的发生，降低患者压疮风险，而且还能增加患者的舒适度，减轻夜间护理人员的工作量。

【关键词】分时段；床头高度；ICU患者；呼吸机相关性肺炎

中图分类号：R563.1 文献标识码：ADOI：10.3969/j.issn.10031383.2015.04.008

【Abstract】ObjectiveTo investigate influence of different bed heights on ICU patients who received ventilator associated pneumonia （VAP） in different periods.Methods364 patients who received invasive mechanical ventilation from January to December，2014 were randomly divided into control group and experimental group with 182 patients in each group.Both groups were given routine nursing according to VAP prevention measures.The bed heights of the experimental group at day and night were 30°to 45°and 20°to 30° respectively，while that of the control group was 30° to 45°all day round.Then，infection rate of VAP， incidence of pressure sores and comfort degree of patients in both groups were compared.Results Infection rate of VAP and incidence of pressure sores of the experimental group were lower than those of the control group（P<0.05），and comfort degree of the former group was higher than that of the later group （P<0.01）.ConclusionTo raise the head of the bed in different heights in different periods can not only effectively prevent the incidence of VAP in ICU patients who receive mechanical ventilation and reduce the risks of getting pressure sores，but also increase the comfort degree of patients as well as lower the workload of nursing staff at night.

【Key words】different periods；bed heights；ICU patients；VAP

呼吸机相关性肺炎（Ventilator Associated Pneumonia，VAP）是机械通气患者在通气治疗48 h后至停用机械通气拔除人工气道48 h内所并发的肺实质感染。研究表明[1]，将机械通气患者的床头抬升至30°～45°可有效降低VAP的发生，但此床头高度降低患者的舒适感。为探究ICU患者舒适体位角度与预防VAP体位管理间的关系，根据VAP发生原因结合人体胃排空规律，我院通过分时段抬升机械通气患者床头不同高度，观察其VAP感染率、压疮发生率及舒适度，现将结果报道如下。

1对象与方法1.1研究对象选取2014年1～12月在我院ICU行有创机械通气并符合入选标准的364例患者作为研究对象，入选标准：行机械通气≥24 h；无床头抬高30°～45°禁忌证（如低血压/血压不稳定、休克、脊柱骨折、骨盆骨折等）；拔管后意识清醒，能进行交流的患者。其中男233例，女131例；年龄18～87岁，平均（51.24±25.17）岁。按入住时间先后顺序编号，奇数入实验组，偶数入对照组，每组182例。实验组男118例，女64例，平均（51.84±26.48）岁，属于计划转入128例，肠内营养154例，机械通气时间（538±1.97）天，机械通气前使用抗生素145例。……