清醒患者俯卧位治疗方案的构建及实践研究

doi:10.3761/j.issn.2096-7446.2023.04.004

摘要/Abstract

摘要： 目的构建并实施清醒患者俯卧位治疗方案,验证清醒患者开展俯卧位治疗的有效性。方法组建多学科救治团队制订清醒患者俯卧位方案,包含俯卧位时机的治疗决策、与患者共同商议俯卧日程、评估患者俯卧位安全性和耐受性、提高耐受性的体位更换方案、个性化时间累计制度以及俯卧位相关知识宣教和心理支持等。2021年9月在福建省某新型冠状病毒感染定点救治医院收治的清醒患者中进行初步应用。结果 136例新型冠状病毒感染患者入院后落实俯卧位治疗措施,每日俯卧位时间为（11.95±2.47）h,住院1周后俯卧位耐受性提高（t=35.254,P<0.05）。133例患者经救治后好转,3例（2.2%）进展为重型,住院时间为（14.95±3.02）d,无严重不良事件发生,俯卧位患者的氧合指标改善（F=5.624,P<0.05）。结论基于多学科救治团队合作的清醒患者俯卧位治疗方案具有可行性和实用性,可为临床改善肺通气实践提供参考和借鉴。

关键词: 俯卧位, 意识清醒, 跨学科研究, 2019冠状病毒性疾病, 危重病护理

Abstract: Objective To develop and implement prone positioning program for awake patients,and explore the feasibility and effeteness of prone positioning in awake patients. Methods The multidisciplinary treatment team was set up to develop the prone positioning program,including treatment decision of awake prone position timing,prone positioning schedule making with patients,prone position safety and tolerance assessment,position replacement scheme to improve tolerance,individualized time accumulation system,and prone position knowledge education and psychological support. The preliminary application was carried out in awake COVID-19 patients admitted to a designated hospital in Fujian province in September 2021. Results 136 patients were treated with awake prone positioning program,the average duration were （11.95±2.47）h. The prone positioning tolerability scores were significantly improved one week after hospital admission（t=35.254,P<0.05）. 133 patients recovered and 3 patients（2.2%）developed to critical illness,the average of hospitalization length was （14.95±3.02）days without serious adverse events during prone positioning. The oxygenation index of patients were significantly improved（F=5.624,P<0.05）. Conclusion The awake prone positioning program based on multidisciplinary treatment team cooperation is feasible and practical,which can provide a reference for the improvement of lung ventilation in clinical practice.

Key words: Prone Position, Awake, Interdisciplinary Research, COVID-19, Critical Care Nursing

何进椅, 陈美榕, 陈晓欢, 陈丽丽, 叶衍, 周晓芬, 谢少华, 李红. 清醒患者俯卧位治疗方案的构建及实践研究[J]. 中华急危重症护理杂志, 2023, 4(4): 309-314.

HE Jinyi, CHEN Meirong, CHEN Xiaohuan, CHEN Lili, YE Yan, ZHOU Xiaofen, XIE Shaohua, LI Hong. Research on the development and practice of prone positioning program for awake patients[J]. Chinese Journal of Emergency and Critical Care Nursing, 2023, 4(4): 309-314.

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