Doering L V
Infant CPR Project, UCLA School of Nursing 90024.
Am J Crit Care. 1993 May;2(3):208-16.
Positioning of critically ill patients affects hemodynamic and cardiopulmonary outcomes. A review of clinical studies indicates that backrest elevations up to 60 degrees do not affect measurement of intracardiac pressures or cardiac output, but PaO2 may diminish in sitting positions following surgical procedures. In lateral positions, measurement of intracardiac pressures and cardiac output is not recommended, since a uniform reference point has not been identified for lateral positions. In patients with unilateral lung disease, PaO2 increases with the unaffected lung in the dependent position. Despite widespread use, the Trendelenburg position has not been shown to provide consistent beneficial effects. Prone positioning may be beneficial in adult respiratory distress syndrome and in weaning of mechanically ventilated patients. When planning positioning maneuvers, critical care nurses should consider these effects in relation to the specific needs of each patient. Hemodynamic and cardiopulmonary responses to positioning should be evaluated in conjunction with other therapeutic modalities such as those designed to preserve skin integrity and improve comfort.
危重症患者的体位会影响血流动力学和心肺功能结局。一项临床研究综述表明，将靠背抬高至60度不会影响心内压或心输出量的测量，但手术后坐位时动脉血氧分压（PaO2）可能会降低。对于侧卧位，不建议测量心内压和心输出量，因为尚未确定侧卧位的统一参考点。对于单侧肺部疾病患者，患侧在下的卧位可使未受影响的肺的PaO2升高。尽管头低脚高位被广泛使用，但尚未证明其能带来持续的有益效果。俯卧位可能对成人呼吸窘迫综合征和机械通气患者的撤机有益。在规划体位调整时，重症护理护士应根据每个患者的具体需求考虑这些影响。应结合其他治疗方式（如旨在保持皮肤完整性和提高舒适度的方式）来评估体位对血流动力学和心肺功能的影响。
