Abstract:

Objective To self-design a split prone positioning cushion and to investigate its effect on prone ventilation of patients with severe acute respiratory distress syndrome（ARDS）. Methods The split prone positioning cushion comprised of 4 parts,including the head and shoulder pad,the hip pad,the elbow pad and the leg pad. A randomized controlled trial was conducted with 60 patients with ARDS requiring prone ventilation in an intensive care unit of a tertiary hospital from March 2017 to November 2019. Participants were randomly allocated to an experimental group and an observation group,with 30 patients in each group. The experimental group used a split prone positioning cushion,while the observation group received the traditional prone position using a soft pillow to elevate the head-thoracic portion. Researchers compared the oxygenation（PaCO₂,PaO₂/FiO₂）,time of operation,duration of treatment and incidence of adverse events（pressure ulcers,ventilator pipeline bending and tube slip-off）between the 2 groups. Results After the treatment,the PaCO₂ in the experimental group was （30.37±2.41） mmHg,and PaO₂/FiO₂ was （288.23±19.34） mmHg. In the control group,PaCO₂ was （38.93±3.59） mmHg,and PaO₂/FiO₂ was（197.53±45.22） mmHg. The operation time was（3.60±0.56） min in the experimental group,and it was（5.63±1.00） min in the observation group. The cumulative time of prone position in experimental group was （46.20±3.40） h,and it was（33.23±2.69） h in the observation group. In the experimental group,the incidence of pressure injury was 23.3%,with the ventilator pipeline bending of 0. In the observation group,the incidence of pressure injury was 53.3%,with the ventilator pipeline bending of 70.0%. The differences were statistically significant between the 2 groups（P<0.05）. The incidence of pipeline slip in the experimental group was 0,and it was 6.7% in the observation group. There was no significant difference between the 2 groups（P=0.492）. Conclusion Compared with traditional ventilation in the prone position,the use of split prone positioning cushion in the prone position can effectively prolong the treatment time,improve the treatment effect,reduce the incidence of adverse nursing events and reduce the workload of medical staff.

Key words: Intensive Care Unit, Acute Respiratory Distress Syndrome, Prone Position Ventilation, Nursing Care

摘要：

目的 自行设计分体式俯卧位通气垫,探讨其在重度急性呼吸窘迫综合征（acute respiratory distress syndrome,ARDS）患者俯卧位通气治疗中的应用效果。 方法 分体式俯卧位通气垫包括头肩垫、髋部垫、手肘垫、腿垫4个部分。便利选取2017年3月—2019年11月在山东省某三级甲等医院重症医学科住院并行俯卧位通气治疗的60例ARDS患者,随机分为试验组和对照组各30例,试验组使用分体式俯卧位通气垫行俯卧位通气治疗,对照组采用软枕将头部和胸部抬高的传统俯卧位通气方式。比较两组氧合情况（PaCO₂、氧合指数）、操作用时、治疗时长及不良事件（压力性损伤、人工气道弯折、人工气道滑脱）发生率。 结果 治疗后,试验组的PaCO₂为（30.37±2.41） mmHg（1 mmHg=0.133 kPa）、氧合指数为（288.23±19.34） mmHg;对照组的PaCO₂为（38.93±3.59） mmHg、氧合指数为（197.53±45.22） mmHg,两组比较,差异均具有统计学意义（P<0.001）。试验组操作用时为（3.60±0.56） min,治疗时长为（46.20±3.40） h;对照组操作用时为（5.63±1.00） min,治疗时长为（33.23±2.69） h,两组比较,差异均具有统计学意义（P<0.001）。试验组压力性损伤发生率为23.3%,人工气道弯折发生率为0;对照组压力性损伤发生率为53.3%,人工气道弯折发生率为70.0%,两组比较,差异具有统计学意义（P<0.05）。试验组人工气道滑脱的发生率为0,对照组为6.7%,两组比较,差异无统计学意义（P=0.492）。 结论 使用分体式俯卧位通气垫能有效延长俯卧位通气治疗时间,改善治疗效果,降低不良事件发生率,减少医护人员工作量。

关键词: 重症监护病房, 急性呼吸窘迫综合征, 俯卧位通气, 护理