目的 评估高侧卧位与俯卧位通气对重症肺炎实施有创机械通气患者呼吸指标、分泌物引流与康复效果的影响.方法 选择2021年月至2023年3月重症肺炎进行有创机械通气患者76例,符合本次研究标准,经综合检查及评估后,明确临床诊断.按照随机编号方式分为对照组和观察组,每组38例.2组有创机械通气均相同,对照组,采用俯卧位通气;观察组采用高侧卧位通气.当符合撤机标准后,予以撤机.记录患者呼吸指标[氧合指数(PaO2/FiO2)、血氧饱和度(SpO2)、呼吸频率(BR)]、气道痰液引流量、康复效果及并发症情况.结果 与改变时比较,2组改变1 h、改变2 h、改变4 h PaO2/FiO2和SpO2升高,BR降低(P＜0.05);与对照组比较,观察组改变1 h、改变2 h、改变4 h PaO2/FiO2和SpO2较高,BR较低(P＜0.05).对照组体位改变1 h、改变2 h、改变4 h气道痰液引流量,低于观察组,差异有统计意义(P＜0.05).对照组机械通气时间、ICU入住时间、住院时间,高于观察组,差异有统计意义(P＜0.05)o对照组28 d死亡率(21.05％)高于观察组(5.26％),差异有统计意义(P＜0.05).对照组的并发症率(23.68％)高于观察组(7.89％),差异有统计意义(P＜0.05).结论 与俯卧位比,高侧卧位可以提高重症肺炎实施有创机械通气患者的康复效果,进一步改善呼吸指标,促进痰液分泌及引流,并发症少,是一种有效的干预方案.
Effects of invasive mechanical ventilation applied in high lateral position versus prone position on respiratory indicators,secretion drainage,and rehabilitation outcomes in patients with severe pneumonia
Objective To evaluate the effects of invasive mechanical ventilation(IMV)applied in high lateral position versus prone position on respiratory indicators,secretion drainage,and rehabilitation outcomes in patients with severe pneumonia.Methods Eligible 76 patients with severe pneumonia visited in our hospital for IMV from January 2021 to March 2023 were enrolled.After comprehensive examination and evaluation,the clinical diagnosis of the patients was confirmed.The patients were randomized 1∶1 to IMV applied in prone position(control group)or IMV applied in high lateral position(observation group).When the withdrawal criteria were met,the machine was withdrawn.The respiratory indicators(oxygenation index[PaO2/FiO2],blood oxygen saturation[SpO2],respiratory rate[BR]),airway sputum flow rate,rehabilitation effect,and complications were recorded between groups.Results Compared with the time of change,the PaO2/FiO2 and SpO2 in the two groups significantly increased on hours 1,2 and 4 of positional changes,while BR significantly decreased(P＜0.05),and the differences were significant in PaO2/FiO2,SpO2 and BR between groups(P＜0.05).The flow rates of airway sputum on hours 1,2 and 4 of positional changes were significantly higher in the observation group than in the control group(P＜0.05).The mechanical ventilation time,ICU stay time,and hospitalization time were significantly shorter in the observation group than in the control group(P＜0.05).The 28-day mortality was significantly lower in the observation group than in the control group(5.26％vs 21.05％,P＜0.05).The complication rate was significantly lower in the observation group than in the control group(7.89％vs 23.68％,P＜0.05).Conclusion Compared with IMV applied in prone position,IMV applied in high lateral position can improve the rehabilitation effect of patients with severe pneumonia,further improve respiratory indicators,promote sputum secretion and drainage,and has fewer complications.It is an effective intervention plan.
high lateral positionprone positionsevere pneumoniainvasive mechanical ventilationrespiratory indicatorsdrainage of secretionsrehabilitation effect
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