何小群　陈松　刘春荣　何丽萍

【摘要】目的探讨自制双面床头角度卡预防机械通气患者呼吸机相关性肺炎（VAP）的作用。方法将160例机械通气患者分为实验组和对照组。实验组80例采用自制双面床头角度卡测量床头高度并保持在30°～45°，对照组80例由护理人员根据自己的经验目测确定患者床头高度为30°～45°；观察两组床头抬高准确率（测量时以床头高度30°～45°判定为抬高准确）和VAP发生率。结果实验组和对照组各测量720例次，实验组床头抬高准确率为10000%，对照组床头抬高准确率为62.36%（449/720），两组床头抬高准确率比较差异有统计学意义（χ2=332.8232，P=0.0000），实验组床头抬高准确率显著高于对照组。实验组发生VAP 9例，发生率为11.25%（9/80）；对照组发生VAP 19例，发生率为23.75%（19/80）；两组比较差异有统计学意义（χ2=4.3290，P=0.0375），实验组的VAP发生率显著低于对照组。结论使用双面床头角度卡辅助机械通气患者的体位护理，操作简单，能有效提高床头抬高准确率，可有效地降低VAP发生率，值得临床进一步推广应用。

【关键词】机械通气；VAP；体位护理；双面床头角度卡

中图分类号：R473.5文献标识码：ADOI：10.3969/j.issn.10031383.2015.06.005

【Abstract】ObjectiveTo study the function of handmade doubleside card of bedside angle in the prevention of ventilator associated pneumonia（VAP）.Methods160 patients with mechanical ventilation were randomly divided into experimental group and control group with 80 cases in each group.Bedside angle in the experimental group was maintained at 30° ～ 45° which was measured by the handmade doubleside card，and that in the control group was maintained at the same angle by nursesvisual measurement.Then，accuracy of bedside angle （the bedside angle at 30° ～ 45° was regarded as the raising standard） and VAP incidence were compared between the two groups.Results Both the experimental group and the control group were measured for 720 times，accuracy of bedside angle was 100% in the experimental group，but it was only 62.36% （449/720） in the control group.Accuracy of bedside angle in the experimental group was significantly higher than that of the control group，so difference was statistically significant （χ2=332.8232，P=0.0000）.VAP was found in 9 cases in the experimental group，and incidence was 11.25%（9/80），but it was found in 19 cases in the control group with incidence of 23.75% （19/80）.The incidence of VAP in the experimental group was obviously lower than that in the control group，so difference was statistically significant （χ2=4.3290，P=0.0375）.Conclusion Handmade double-side card of bedside angle can be easily operated in auxiliary body position nursing in patients with mechanical ventilation，which can effectively improve the accuracy of bedside angle，reduce VAP incidence.Thus it is worthy of further promotion and application in clinic.

【Key words】mechanical ventilation；VAP；nursing position；doubleside card of bedside angle

随着重症医学的发展，机械通气的患者不断增多，呼吸机相关性肺炎（VAP）亦随之增加，已成为影响机械通气患者预后的重要因素[1]。研究认为[2]，床头抬高30°～45°的半坐卧位可有效预防VAP 的发生。但目前临床上绝大多数床头抬高措施都是根据护理人员的经验目测确定，因此抬高床头角度与体位需要的30°～45°差距较大，临床需要一种准确的测量工具来解决床头抬高准确性的问题。基于此，本研究研制出双面床头角度卡应用于临床中，现将应用结果报道如下。……