头低足高俯卧位降低儿科ICU呼吸机相关性肺炎的效果

目的探讨合理的体位管理方案以降低儿科ICU机械通气患儿呼吸机相关性肺炎(VAP)的发生率。方法选取2013年6月-2017年6月收治于华中科技大学同济医学院附属同济医院儿童重症医学科行机械通气的460例患儿为研究对象。按使用机械通气的前后顺序交替分为观察组(n=230)和对照组(n=230)。两组患儿在对症支持治疗和机械通气常规护理的基础上给予不同的体位管理方案,每2~3小时改变体位1次。观察组给予头低足高倾斜俯卧位与其他体位交替进行,对照组则给予常规仰卧位与侧卧位交替进行。比较两组患儿机械通气前5天痰液引流量、两组患儿胸片改善时间、机械通气持续时间、VAP发生率以及相关并发症发生率。结果观察组患儿机械通气前5天内痰液引流量较对照组更多,观察组患儿胸片改善时间及机械通气持续时间均少于对照组,且VAP发生率均低于对照组(均P<0.05),两组患儿并发症发生率无明显差异(P>0.05)。结论在儿科ICU机械通气患儿中采取头低足高倾斜俯卧位可以显著提高患儿的通气效果,降低机械通气持续时间和VAP发生率,且不会增加相关并发症风险。

Effect of Trendelenburg/Prone Position on Reducing Ventilator Associated Pneumonia in Pediatric Intensive Care Unit(PICU)

Objective To reduce the incidence of ventilator associated pneumonia in children undergoing mechanical ventilation in PICU by exploring the appropriate position. Methods From June 2013 to June2017, 460 children undergoing mechanical ventilation in PICU of Tongji Hospital, Tongji Medical College,HUST were enrolled in this study. They were alternately allocated into the observation group(n=230) and the control group(n=230) according to the order in which they underwent mechanical ventilation. The children in the two groups were at different positions when receiving symptomatic and supportive treatment as well as routine nursing such as mechanical ventilation, and the position was changed once every 2 to 3 hours. In the observation group, patients took the trendelenburg/prone position and other positions alternatively, while the patients in the control group alternately took the conventional supine position and lateral position. Sputum drainage volume in the first 5 days of mechanical ventilation, time for improving chest radiograph, duration of mechanical ventilation, incidence of VAP and incidence of related complications were compared between the two groups. Results The sputum drainage volume in the first 5 days of mechanical ventilation in the observation group was more than that in the control group, the time for improving chest radiograph and the duration of mechanical ventilation in the observation group were less than that in the control group, the incidence of VAP in the observation group was lower than that in the control group(all P<0.05), and there was no significant difference in the incidence of complications between the two groups. Conclusion For patients undergoing mechanical ventilation in PICU, taking a trendelenburg/prone position can significantly improve the ventilation effect, and reduce the duration of mechanical ventilation and the incidence of VAP, without increasing the risk of related complications.