基于肠内营养耐受性评分的俯卧位通气患者早期肠内营养实施

目的 探讨肠内营养耐受评估表在急性呼吸窘迫综合征（ARDS）行俯卧位通气患者早期肠内营养（EN）中的应用效果。方法 将2014年12月至2019年12月收治的ARDS行俯卧位通气患者30例，按入科时间分为对照组（n=12）和观察组（n=18）。对照组按常规护理方法实施早期肠内营养，观察组在常规护理基础上应用肠内营养耐受评估表指导早期肠内营养的实施。比较两组俯卧位通气治疗期间EN耐受情况、72 h内70%目标热量达标率、达70%目标热量时间，机械通气时间、俯卧位通气时间、俯卧位通气前后前白蛋白指标及ICU住院时间等。结果 观察组达70%目标热量的时间显著短于对照组（P<0.05）,且观察组喂养量及72 h内70%目标热量达标率显著高于对照组（P<0.05，P<0.01）。两组胃肠道并发症发生率及预后指标方面比较，差异无统计学意义（均P＞0.05）。结论 肠内营养耐受性评估表在指导行俯卧位通气治疗患者早期肠内营养的护理中具有重要的价值，能规范早期肠内营养方案，及早发现并积极防治肠内营养不耐受情况，对提高俯卧位通气患者早期肠内营养支持成功率有重要的意义。     

心脏病开胸术后俯卧位通气清单式管理效果观察

目的 提高心脏开胸术后患者低氧血症俯卧位护理效果与安全。方法 将110例患者按时间段分为对照组与观察组各55例；对照组采取“信封法”实施俯卧位操作和常规护理；观察组制定和实施俯卧位操作清单。结果 观察组俯卧位准备时长、俯卧位治疗结束后机械通气时长、面部水肿发生率显著少于对照组(均P<0.05),观察组俯卧位总时长显著长于对照组、转换仰卧位后氧合指数显著高于对照组(均P<0.05)。结论 清单式管理优化了心脏开胸术后患者俯卧位操作流程，有效提高护理效率，增加俯卧位通气效果，减少相关并发症，有利于保障患者安全和尽早脱离呼吸机。     

意识障碍气管切开后肺部感染患者侧俯卧位引流效果探讨

目的 探讨侧卧位引流在意识障碍气管切开患者肺部感染中的应用效果。 方法 选取神经重症康复单元意识障碍气管切开非机械通气肺部感染患者70例,按入院时间分为对照组30例和观察组40例。对照组给予常规人工气道管理,观察组在对照组的基础上实施特定节段3/4俯卧位引流。 结果 干预1周后,观察组自主排痰改善程度显著优于对照组;干预后14 d及28 d观察组肺部渗出完全吸收率显著高于对照组,住院期间肺部感染抗生素治疗时间显著短于对照组（P＜0.05,P＜0.01）。 结论 侧俯卧位引流在意识障碍气管切开患者肺部感染中的应用能够有效清除气道分泌物,促进肺部渗出物吸收,缩短抗生素治疗时间。     

重症眼表疾病患者结膜角膜缘异体移植的护理

目的探讨充气式颈椎牵引器应用于玻璃体切割联合填充物术后的方法及效果。方法将玻璃体切割术后需面向下体位的80例患者随机均分为观察组和对照组。对照组予常规俯卧体位，观察组使用气垫作为额面部支撑。观察两组俯卧位的时间、不适反应发生情况及患者舒适度。结果观察组保持俯卧体位时间显著长于对照组（P〈0．01），眼睑水肿发生情况及舒适度显著优于对照组（均P〈0．01）；颈腰疼痛出现的时间显著长于对照组（P〈0．01）。结论充气式颈椎牵引器应用于玻璃体切割术后俯卧体位支撑减少了不适反应，增加了患者的舒适度．有利于患者术后康复。     

玻璃体切割术后充气式颈椎牵引器的应用

目的 探讨充气式颈椎牵引器应用于玻璃体切割联合填充物术后的方法及效果.方法 将玻璃体切割术后需面向下体位的80例患者随机均分为观察组和对照组.对照组予常规俯卧体位,观察组使用气垫作为额面部支撑.观察两组俯卧位的时间、不适反应发生情况及患者舒适度.结果 观察组保持俯卧体位时间显著长于对照组(P＜0.01),眼睑水肿发生情况及舒适度显著优于对照组(均P＜0.01);颈腰疼痛出现的时间显著长于对照组(P＜0.01).结论 充气式颈椎牵引器应用于玻璃体切割术后俯卧体位支撑减少了不适反应,增加了患者的舒适度,有利于患者术后康复.     

重症胰腺炎合并急性呼吸窘迫症的临床护理

目的 探讨重症胰腺炎合并急性呼吸窘迫症的临床特点以及护理方法.方法 将2011年1月至2013年2月期间我院收治的80例重症胰腺炎合并急性呼吸窘迫症患者随机分为对照组和观察组（各40例）,两组患者均采用常规综合治疗重症胰腺炎,并给予无创通气治疗,对照组患者给予常规基础护理,观察组患者则在常规护理的基础上给予护理干预,治疗结束后比较两组患者的临床效果.结果 观察组患者的治疗有效率（85.0％）明显高于对照组患者（75.0％）,观察组患者的病死率（5.0％）明显低于对照组患者（20.0％,差异均有统计学意义（P＜ 0.05）;对照组治疗有效患者的机械通气时间和住院时间均明显长于观察组治疗有效患者,差异均有统计学意义（P＜ 0.05）.结论 有效的护理干预,包括有效的心理护理,机械通气护理、呼吸道护理以及营养支持等,可以显著降低重症胰腺炎合并急性呼吸窘迫症的病死率,减少患者的机械通气时间和住院时间,值得临床推广应用.     

头高足低俯卧位对脊柱侧弯矫治手术患者眼压的影响

目的预防俯卧位脊柱侧弯矫治手术患者球结膜水肿。方法将86例脊柱侧弯矫治手术患者按手术时间先后排序分为两组各43例,对照组采用常规俯卧位手术,观察组在常规俯卧位基础上适时采用头高足低俯卧位。观察两组手术不同时间的眼压及术后球结膜水肿发生率。结果两组术前眼压比较,差异无统计学意义(P0.05);手术不同时间眼压比较,干预主效应、时间主效应和交互效应均P0.05;手术结束时观察组球结膜水肿发生率显著低于对照组(P0.05)。结论适时采用头高脚低俯卧位可有效缓解脊柱侧弯矫治手术患者术中眼压升高,预防球结膜水肿的发生。     

转变体位护理对新生儿肺炎患儿的影响

目的探讨转变体位护理对新生儿肺炎治疗效果的影响。方法将符合纳入标准的新生儿肺炎患儿69例,随机分为观察组35例和对照组34例。对照组给予常规体位及气道护理;观察组在常规护理基础上采用转变体位护理,即按照头高脚低斜坡卧位30min、仰卧位或自由体位3h、30°头低脚高的左侧卧位30min、仰卧位或自由体位3h、30°头低脚高的右侧卧位30min、仰卧位或自由体位3h、头低脚高俯卧位30min、仰卧位或自由体位3h的顺序轮换体位。比较两组治疗效果,入院1d、3d、7d血氧饱和度、呼吸频率、心率以及住院时间。结果观察组干预后血氧饱和度、呼吸频率、心率显著改善,治疗效果显著优于对照组,住院时间显著短于对照组(P0.05,P0.01)。结论采用转变体位护理能促进新生儿肺炎患儿痰液排出,改善患儿肺功能,缩短住院时间。     

不同角度俯卧位对ARDS患者早期氧合及肠内营养耐受性的影响

目的 比较三种头高足低位角度对ARDS俯卧位通气患者早期氧合及肠内营养耐受性的影响。 方法 将ICU收治的45例ARDS患者随机分为0°、30°和45°头高足低俯卧位组14例、16例和15例,观察比较俯卧位后5 d内的氧合指数、胃残余量和肠内营养相关并发症发生情况。 结果 俯卧位5 d后三组氧合指数均有改善,其中0°组与30°组氧合指数显著高于45°组（均P＜0.05）。俯卧位第4天,30°组与45°组胃残余量显著少于0°组（均P＜0.05）。非0°组反流发生率显著低于0°组（P＜0.05）。 结论 ARDS患者取30°头高足低俯卧位通气可以有效改善氧合,提高喂养耐受性,降低肠内营养并发症发生率。     

气囊上滞留物清除预防呼吸机相关性肺炎

目的 观察气囊上滞留物清除技术对降低机械通气患者呼吸机相关性肺炎（VAP）发生率的作用。方法 将58例行气管插管机械通气治疗48h以上患者随机分为观察组（32例）和对照组（26例），对照组采用常规气道护理，观察组在此基础上实施气囊上滞留物清除技术。观察两组机械通气1周、2周及2周后VAP发生率以及机械通气时间。结果 机械通气1周、2周观察组VAP发生率显著低于对照组（均P〈0．05），机械通气时间显著短于对照组（P〈0．01）。结论 气囊上滞留物清除技术可显著减少VAP的发生，缩短机械通气时间，但气囊上滞留物并不是引起VAP的唯一因素。     

Combined effects of prone positioning and airway pressure release ventilation on gas exchange in patients with acute lung injury

BACKGROUND: Prone positioning has been shown to improve oxygenation in 60-70% of patients with acute lung injury (ALI) or acute respiratory distress syndrome (ARDS). Another way to improve matching of ventilation to perfusion is the use of partial ventilatory support. Preserving spontaneous breathing during mechanical ventilation has been shown to improve oxygenation in comparison with controlled mechanical ventilation. However, no randomized studies are available exploring the effects of preserved spontaneous breathing on gas exchange in combination with prone positioning. Our aim was to determine whether the response of oxygenation to the prone position differs between pressure-controlled synchronized intermittent mandatory ventilation with pressure support (SIMV-PC/PS) and airway pressure release ventilation with unsupported spontaneous breathing (APRV). METHODS: We undertook a prospective randomized intervention study in a medical-surgical adult intensive care unit of a university hospital. Of 45, 33 ALI patients (acute lung injury) within 72 h after initiation of mechanical ventilation, and in whom the prone position was applied according to a predefined strategy, were included in the study. After initial stabilization the patients were randomized to receive either SIMV-PC/PS or APRV with predefined general ventilatory goals (PEEP, tidal volume, inspiratory pressure and PaCO2-level). The protocol for prone positioning was the same for both treatment arms. Prone positioning was triggered by finding a PaO2/FiO2-ratio below 200 mmHg evaluated twice per day. The duration of each prone episode was 6 h. RESULTS: The first two episodes of prone positioning were analyzed. Gas exchange was measured before and at the end of prone positioning. Of the 45 patients enrolled, 33 were turned prone once and 28 twice. No significant differences were detected in baseline characteristics. Changes in oxygenation were analyzed in response to the first and second prone episodes 5 h and 24 h after randomization and initiation of SIMV-PC/PS or APRV respectively. Before the first prone episode the PaO2/FiO2-ratio was significantly better (P = 0.02) in the APRV-group (median; interquartile range) (162; 108-192 mmHg) than in the SIMV-PC/PS-group (123; 78-154 mmHg). The response in oxygenation to the first prone episode was similar in both groups: PaO2/FiO2-ratio increased 39.5; 17.75-77.5 mmHg in the SIMV-PC/PS-group and 75.0; 9.0-125.0 mmHg in the APRV-group (P = 0.49). Before the second prone episode, the PaO2/FiO2-ratio was comparable (SIMV-PC/PS 130.5; 61.0-161.0 mmHg vs. APRV 134; 98.3-175.0 mmHg). Improvement in oxygenation was significantly (P = 0.02) greater in the APRV group (82; 37.0-141.0 mmHg) than in the SIMV-PC/PS group (50; 24.0-68.8 mmHg) during the second prone episode. General ventilatory and hemodynamic variables and use of sedatives were similar in both groups during the study. CONCLUSIONS: APRV during prone positioning is feasible in the treatment of ALI patients. APRV after 24 h appears to enhance improvement in oxygenation in response to prone positioning.     

神经外科侧卧位手术的体位改良联合流程化安置

目的探讨体位改良联合流程化安置方法在神经外科侧卧位手术的应用效果。方法将神经外科行侧卧位手术患者60例,按照手术时间单双日分为观察组和对照组各30例。观察组采用体位改良联合流程化安置方法,对照组采用常规体位安置方法,比较两组手术体位安置耗时、体位稳定性、术后并发症及手术人员满意情况。结果观察组安置体位时间、术中体位移动情况显著短于和少于对照组,术后压力性损伤、外周神经损伤和颈部拉伤发生率显著低于对照组,医生、护士和麻醉医生满意度显著高于对照组(P<0.05,P<0.01)。结论采用体位改良联合流程化安置方法可降低神经外科手术风险及体位并发症发生率,提高手术人员满意度。     

Response to the prone position in spontaneously breathing patients with hypoxemic respiratory failure

OBJECTIVES: The prone position is used for intubated patients with adult respiratory distress syndrome (ARDS) and acute lung injury (ALI). The physiological changes associated with the prone position in nonintubated patients may be even more favorable than in intubated patients. We examined the effect of the prone position on arterial blood gases and patient compliance in four awake, nonintubated patients with hypoxemic respiratory failure. DESIGN: We present four consecutive cases of hypoxemic respiratory failure, in which mechanical ventilation was indicated. An attempt was made to avoid assisted ventilation by placing patients in the prone position, while breathing spontaneously. The effect on the clinical condition and the changes in blood gases were registered. RESULTS: We found good patient tolerance. A rapid increase in PaO2 was found, and intubation was avoided in all patients. No significant complications were registered. CONCLUSION: The prone position may prove beneficial in some cases of hypoxemic respiratory failure, even in awake patients, by avoiding mechanical ventilation and ventilator-associated complications.     

斜仰截石位与俯卧位在治疗合并通气功能障碍的上尿路结石患者的疗效比较

目的 对比斜仰截石位与俯卧位在治疗合并通气功能障碍的上尿路结石患者中的应用安全性及疗效.方法 回顾性分析201 1年10月至2013年10月,采用斜仰卧截石位与俯卧位治疗的合并通气功能障碍的上尿路结石患者60例的资料.结果 60例手术均顺利.手术时间斜仰截石位组（50.4±26.4）min,俯卧位组（50.2±31.4）min;术后复查KUB,一期结石清除率斜仰截石位组83.3％,俯卧位组80.0％;两组术中均无严重并发症发生.斜仰截石位组生命体征变化出现时间（40±5.8）min,俯卧位组生命体征变化出现时间为（30±3.8）min,术中出现血压变化、心率变化、心律变化、呼吸变化,斜仰截石位组均小于俯卧位组.结论 斜仰截石位经皮肾镜取石术具有创伤小安全性高等优点,尤其适用于合并通气功能障碍的上尿路结石患者.     

Modified prone position using lateral brace attachments for cervico-dorsal spine surgeries

Purpose

The purpose of the study was to propose a method of prone positioning for posterior cervico-dorsal spine surgeries that is easy to achieve without additional equipment and may reduce complications associated with prone positioning in patients.

Methods

41 patients underwent posterior spine surgeries using our method of prone positioning on a fluoroscopy compatible conventional operation table, and the technical difficulties and complications associated were noted. After induction under general anaesthesia in supine position, cervical tongs were applied. An assembly of two adequately padded cylindrical bolsters and two lateral brace attachments was set on a conventional operating table. The patient was then positioned prone so that the tongs as well as insertion pins of the tongs rest on the lateral brace attachments, with the face and head suspended freely in between. A neutralisation weight was then applied suspended from the tongs to stabilize the head.

Results

The time required for patient positioning was noted and was found to be nearly the same as that required for traditional prone positioning. No problems were noted during patient positioning and with anaesthesia tubing management. All surgeries went well without position related complications except for one patient who developed post-operative macroglossia. All cervical tong pin sites healed without any complications. The fluoroscope easily gained access to the operative areas.

Conclusions

Our modification appears simple, versatile and reproducible for posterior approach procedures of the cervical and upper dorsal spine in prone position. Also, the method can be easily implemented in most conventional operating room facilities with minimal surgeon effort and without the need for any additional inventory.     

Effects of prone and supine posture on cardiopulmonary function after experimental chlorine gas lung injury

BACKGROUND: Chlorine gas may induce severe acute lung injury. Improvement of pulmonary gas exchange in patients and animals with acute lung injury nursed in the prone position was observed in recent years. The purpose of this study was to evaluate the effects of prone and supine positions on pulmonary and cardiovascular functions following experimental chlorine gas lung injury. METHODS: Twenty anesthetized and mechanically ventilated pigs were exposed to chlorine gas (400 p.p.m. in air) for 20 min in the supine position, then assigned randomly to ventilation in the supine or prone positions (n=10 in each group). Hemodynamics, gas exchange, lung mechanics and oxygen transport were evaluated for 5 h. RESULTS: All animals showed severe pulmonary dysfunction immediately after chlorine gassing with a threefold increase in pulmonary vascular resistance index, a drop in arterial oxygenation (12.3+/-1.3 kPa to 5.4+/-0.7 kPa) and a fall in lung-thorax compliance (22+/-1 ml cmH2O-1 to 8+/-2 ml cmH2O-1). Venous admixture (Qs/Qt) improved in animals in the prone position while there was no change in the supine position (prone 32+/-11% vs. supine 42+/-9% at 5 h,P<0.05). Lung-thorax compliance improved significantly with time in the prone group only (P<0.01). Oxygen delivery increased significantly in prone animals compared with animals nursed in the supine posture (P<0.001). CONCLUSION: Immediate prone positioning after chlorine gas injury not only inhibited deterioration of gas exchange but was also associated with improved pulmonary function and oxygen transport.     

Better postoperative oxygenation in thoracoscopic esophagectomy in prone positioning

Intrathoracic procedures can be performed with thoracoscopy in esophagectomy because the laparoscopic technique has recently been developed. During intrathoracic procedures, prone positioning of the patient allows gravity to facilitate optimal exposure of the esophagus, thereby affording a superb surgical view. In the current study, we compared the influence of prone positioning with lateral decubitus positioning on oxygenation in esophagectomy. We enrolled 18 patients and divided them into two groups: patients who underwent esophagectomy via thoracoscopy in the prone position (group P) and patients who underwent thoracotomy in the lateral decubitus position (control group, group L). Arterial blood gas analyses were performed before the operation was started (T1), 20 min after the initiation of one-lung ventilation (OLV) (T2), and two other points. The P/F ratio at T2 in group P was higher. Further, percent (%) change of the P/F ratios from T1 and thereafter in group P was higher at all points. We thought the reason why the prone position had contributed to maintenance oxygenation was as follows. First, the functional residual capacity and ventilation/perfusion matching in the prone position are satisfactory. Second, a bronchial blocker might contribute to reduction of atelectasis. Third, minimally invasive esophagectomy might reduce respiratory complications and blood loss because this procedure reduces edema and inflammation in the lung. In conclusion, the oxygenation provided by prone positioning is better than that provided by the lateral decubitus position during OLV in esophagectomy.     

机器人辅助腹腔镜下前列腺癌根治性切除术改良仰卧位与常规体位的对照研究

目的:探讨第四代达芬奇机器人Xi系统辅助腹腔镜下前列腺癌根治性切除手术采取改良仰卧位的优势。方法:选取2019年12月—2021年1月在贵州省人民医院接受达芬奇机器人Xi系统辅助腹腔镜下前列腺癌根治性切除手术的90例患者为研究对象,按手术顺序随机将研究对象分为三组,分别为对照组A、对照组B和观察组C,每组各30例。对照组A采取常规头低脚高截石位,对照组B采用头低脚高"人"字形体位,观察组C采用改良仰卧位。比较三组手术体位摆放用时、手术用时、术中失血量及术中并发症的发生率。结果:所有手术均顺利完成,手术用时、术中失血量及相关术中并发症的发生率差异无统计学意义(P>0.05)。但采用设计改良仰卧体位摆放时间较常规采取截石位与"人"字形体位短(P<0.05)。结论:达芬奇手术机器人Xi系统辅助腹腔镜下前列腺癌根治性切除术中采用改良仰卧位,能够缓解常规体位拆卸托腿架带来的体力消耗,缩短摆放体位时间,预防常规体位术中可能带来的压力性损伤与术中并发症,值得推广。     

Prone positioning improves oxygenation in post-traumatic lung injury--a prospective randomized trial

BACKGROUND: In a prospective randomized trial the effect of prone positioning on the duration of mechanical ventilation was evaluated in multiple trauma patients and was compared with patients ventilated in supine position. METHOD: Multiple trauma patients of the intensive care units of two university hospitals were considered eligible if they met the criteria for acute lung injury or the acute respiratory distress syndrome. Patients in the prone group (N = 21) were kept prone for at least eight hours and a maximum of 23 hours per day. Prone positioning was continued until a PaO2:FiO2 ratio of more than 300 was present in prone as well as supine position over a period of 48 hours. Patients in the supine group (N = 19) were positioned according to standard care guidelines. RESULTS: The duration of ventilatory support did not differ significantly (30 +/- 17 days in the prone group and 33 +/- 23 days in the supine group). Worst case analysis (death and deterioration of gas exchange) displayed ventilatory support for 41 +/- 29 days in the prone group and 61 +/- 35 days in the supine group (p = 0.06). The PaO2:FiO2 ratio increased significantly more in the prone group in the first four days (p = 0.03). The prevalence of Acute Respiratory Distress Syndrome (ARDS) following acute lung injury (p = 0.03) and the prevalence of pneumonia (p = 0.048) were reduced also. One patient in the prone and three patients in the supine group died due to multi organ failure (p = 0.27). CONCLUSIONS: Intermittent prone positioning was not able to reduce the duration of mechanical ventilation in this limited number of patients. However the oxygenation improved significantly over the first four days of treatment, and the prevalence of ARDS and pneumonia were reduced.