机械通气危重病人卧位与中心静脉压的关系研究

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Abstract  Objective：To explore relationship between decubitus position of severe patients with mechanical ventilation and their central venous pressure（CVP）.Methods：Nine severe patients with mechanical ventilation admitted to department of critical care medicine of a tertiary grade A hospital in Datong city were selected as study subjects.CVP was measured at four fixed time points every day with four kinds of decubitus position.Generalized estimating equations was established by selecting uncertain operation correlation matrix.Results：Decubitus position was related to CVP measurement.There was no significant difference in CVP values between half decubitus position with head of the bed raised by 30° and supine position（P=0.272），and the CVP values of the two decubitus position were highly correlated（r=0.751，P<0.001）.The CVP value of position with head of the bed raised by 30° combined with left side decubitus 30° was about 5.564 cmH2O lower than that of the supine position（P<0.001），with a large deviation.The CVP value of position with head of the bed raised by 30° combined with right side decubitus 30° was about 0.800 cmH2O lower than that of the supine position（P=0.031），When measured at 21：00，became older，and the CVP value was higher in position with head of the bed raised by 30° combined with right side decubitus 30°，the heart rate and respiratory rate were faster in position with head of the bed raised by 30° combined with right side decubitus 30°，24 h input and output amount was less，the CVP value of supine position was higher.The predictive effect of generalized estimating equations on CVP value of supine position was better than that of direct substitution with CVP value of position with head of the bed raised by 30° combined with right side decubitus 30°（t=2.181，P=0.033）.Conclusions：Severe patients with mechanical ventilation who can not measure CVP value in supine position can consider take the CVP value of half decubitus position with head of the bed raised by 30° as the estimated value of the CVP value of supine position first.they can also consider to measure CVP value of position with head of the bed raised by 30° combined with right side decubitus 30°，and estimate the CVP value of supine position by prediction model proposed in this study.

Keywords  mechanical ventilation； severe patients； central venous pressure； posture； generalized estimating equations； nursing

摘要  目的：探讨机械通气危重病人不同卧位与中心静脉压（CVP）的关系。（剩余7055字）