周伟

【摘要】目的 探讨ICU严重肺部感染行机械通气患者床头抬高的不同角度对中心静脉压的（CVP）影响。方法 选取ICU收治的严重肺部感染致呼吸衰竭行机械通气患者48例，按照患者收治顺序随机均分为对照组和观察组各24例。观察组患者取平卧位，对照组患者取平卧位下自15°递增至60°分四个水平抬高床头。观察比较两组患者CVP值及HR、MAP及SpO2参数。结果 观察组CVP值明显高于对照组四个角度CVP值，对照组四个不同抬高床头水平的CVP值依次递减，卧位角度越大相应的CVP值越小；差异有统计学意义（P<0.05）。经监测两组患者HR、MAP及SpO2参数，差异无统计学意义（P>0.05）。结论 ICU严重肺部感染行机械通气患者床头抬高的不同角度均影响其CVP 值，病情危重患者在测量CVP时应尽量保持原

体位。

【关键词】严重肺部感染；机械通气；床头抬高；CVP

【中图分类号】R563 【文献标识码】A 【文章编号】ISSN.2095-6681.2017.29..02

【Abstract】Objective To investigate the effect of different angles of the bedside elevation on central venous pressure （CVP） in patients with severe pulmonary infection in ICU.Methods Forty-eight patients with respiratory failure were randomly divided into control group and observation group（24 cases）according to the order of patients treated with ICU. The patients in the observation group were given supine position. In the control group， the bed was raised from 15°to 60° in four horizontal positions. The CVP and HR， MAP and SpO2 parameters were observed and compared between the two groups.Results The CVP of the observation group was significantly higher than that of the control group.The CVP values of the four different elevation bed levels in the control group were decreased in descending order， and the smaller the CVP was， the smaller the CVP was.The difference was statistically significant （P<0.05）. There was no significant difference in HR，MAP and SpO2 parameters between the two groups （P>0.05）. Conclusion ICU severe

pulmonary infection in patients with mechanical ventilation in bedside elevation of different angles affect their CVP value， critically ill patients in the measurement of CVP should try to maintain the original position.

【Key words】Severe pulmonary infection；Mechanical ventilation；Bedside elevation；CVP

ICU收治的嚴重肺部感染患者多为长期慢性基础疾病合并多种细菌感染导致呼吸功能衰竭状态，患者入院时多处于危重甚至昏迷状态，患者咳痰无力加之抵抗力低，借助呼吸机辅助机械通气治疗极为常见，但是呼吸机治疗尤其是有创模式更容易引发呼吸机相关肺炎，所以加强呼吸机机械通气管理和护理，对加快患者进一步救治进展非常重要[1]。中心静脉压（CVP）是指血液流经右心房或上、下腔静脉近右心房处的压力，严重肺部感染机械通气患者监护治疗过程中通常会监测CVP水平，通过CVP值来判断患者病情进展状况，并指导液体复苏方案的制定和实施[2]。机械通气患者监测CVP时通常采取平卧位，但严重肺部感染呼吸衰竭患者常合并心功能不全，患者由于疾病原因常处于半卧位或坐位。……