姚雪莲 黄爱萍 苏惠清 李惠文 熊德芳

[摘要]目的 探讨适宜的床头抬高角度对预防呼吸机相关性肺炎（VAP）发生的影响。方法 选取2013年1月～2017年12月惠州市第六人民医院收治的150例机械通气患者作为研究对象，按照床头抬高角度的不同，将其分为3组，A组50例患者床头抬高<30°，B组50例患者床头抬高30°～45°，C组50例患者床头抬高>45°。比较不同床头抬高角度下VAP的发生率及不良反应总发生率。观察、分析不同床头抬高角度下三组患者的心率、呼吸频率差异。结果 A组患者的心率和呼吸频率高于B组，差异有统计学意义（t=3.294、2.256，P<0.05）；C组患者的心率和呼吸频率高于B组，差异有统计学意义（t=2.887、2.105，P<0.05）；A组患者的VAP发生率高于B组，差异有统计学意义（χ2=7.376，P<0.05），C组患者的VAP发生率高于B组，差异有统计学意义（χ2=4.882，P<0.05）；B、C组患者的不良反应总发生率明显低于A组，差異有统计学意义（P<0.05）。结论 床头抬高30°，有利于卧床患者的呼吸，对于留置胃管肠内营养的患者来说，还能够提高胃肠蠕动，减少食物反流，防止误吸发生；对于危重机械通气患者，床头抬高30°，更是预防VAP的重要措施。

[关键词]床头抬高角度；预防；呼吸机相关性肺炎；成效

[中图分类号] R563.1 [文献标识码] A [文章编号] 1674-4721（2018）12（c）-0203-04

[Abstract] Objective To investigate the effect of appropriate bed elevation angle on the prevention of ventilator-associated pneumonia （VAP）. Methods A total of 150 patients with mechanical ventilation admitted to Huizhou Sixth People′s Hospital from January 2013 to December 2017 were enrolled. The patients were divided into three groups according to different angles of bed elevation.In group A （n=50）， bedside elevation <30°； in group B （n=50）， bed elevation was between 30° to 45°； in group C group （n=50）， the bed elevation was >45°. The incidence of VAP and total incidence of adverse reactions under different bed elevation angles were compared. The heart rate and respiratory rate of the three groups under different bed elevation angles were observed and analyzed. Results The heart rate and respiratory rate of group A were higher than those of group B （t=3.294 and 2.256； P<0.05）. The heart rate and respiratory rate of group C were higher than those of group B with statistical significance （t=2.887 and 2.105； P<0.05）. The incidence of VAP in group A was higher than that in group B with a statistical difference （χ2=7.376； P<0.05）. The incidence of VAP in group C was higher than that in group B with a significant difference （χ2=4.882； P<0.05）. The total incidence of adverse reactions in group B and group C was significantly lower compared with that in group A with statistical significance （P<0.05）. Conclusion The bed elevation of 30° is beneficial to the breathing of bedridden patients. For patients with indwelling gastric tube for nutrition support， the angle can also enhance gastrointestinal peristalsis， reduce food reflux and prevent aspiration. For patients with critical mechanical ventilation， the angle is an important measure to prevent VAP.

[Key words] Bedside elevation angle； Prevention；Ventilator-associated pneumonia； Effectiveness

随着医疗技术的发展和人们日益增长的医疗救治需求，机械通气（mechanical ventilation，MV）的患者越来越多，随之而来的是MV并发症-呼吸机相关性肺炎（ventilator associated pneumonia，VAP）发生率的增加，从而增加了患者的ICU住院时间、治疗费用和死亡风险[1-2]。VAP是在拔管48 h或通过呼吸机管道治疗48 h之后，原先无肺部感染的呼吸衰竭者受到病原体肺部感染，形成新的呼吸机相关性肺炎疾病[3]。呼吸机管路污染和胃内容物、口腔分泌物反流、误吸被认为是VAP的重要发病机制，因此，临床普遍采取床头抬高、定期更换呼吸机管路、呼吸机热湿化等预防措施，在一定程度上降低了VAP发生率[4]。床头抬高角度关乎到VAP的预防以及临床治疗效果，有研究证明，适当的抬高床头抬高测量角度能够有效预防呼吸机相关性肺炎疾病的产生，降低发病率，提升临床治疗效果。本研究选取惠州市第六人民医院收治的150例机械通气患者作为研究对象，探讨床头抬高角度在预防VAP发生中的成效，现报道如下。……