Grap M J, Cantley M, Munro C L, Corley M C
Adult Health Nursing Department, Virginia Commonwealth University, Richmond, Va., USA.
Am J Crit Care. 1999 Jan;8(1):475-80.
Use of lower backrest positions occurs frequently and is a factor in the development of ventilator-associated pneumonia.
To determine the usual bed elevation and backrest position in a medical intensive care unit and their relationship to hemodynamic status and enteral feeding.
Data were collected in a 12-bed medical respiratory intensive care unit for 2 months. A protractor was used to measure the elevation of the head of the bed. Hemodynamic status was defined by systolic, diastolic, and mean arterial blood pressure measurements retrieved from each patient's flow sheet.
The sample included 347 measurements of 52 patients. Mean backrest elevation was 22.9 degrees, and 86% of patients were supine. Backrest position differed significantly (P = .005) among nursing shifts (days, evenings, nights) but not for systolic (r = -0.04, P = .49), diastolic (r = 0.01, P = .83), or mean arterial blood pressure (r = -0.01, P = .84). Backrest elevation did not differ significantly between patients who were receiving enteral feedings and patients who were not (P = .23) or between patients receiving intermittent versus continuous nutrition (P = .22).
Use of higher levels of backrest elevation (> or = 30 degrees) is minimal and is not related to use of enteral feeding or to hemodynamic status. The rationale for using lower backrest positions for critically ill patients may be based on convenience, the patient's comfort, or usual patterns in the unit. However, the dangers of supine positioning and its relationship to aspiration and ventilator-associated pneumonia should not be minimized.
经常采用较低的靠背位置，这是呼吸机相关性肺炎发生的一个因素。
确定医学重症监护病房中通常的床头抬高角度和靠背位置，以及它们与血流动力学状态和肠内营养的关系。
在一个有12张床位的医学呼吸重症监护病房收集了2个月的数据。使用量角器测量床头抬高角度。血流动力学状态通过从每位患者的病历表中获取的收缩压、舒张压和平均动脉压测量值来定义。
样本包括52例患者的347次测量。平均靠背抬高角度为22.9度，86%的患者为仰卧位。不同护理班次（白天、晚上、夜间）之间的靠背位置有显著差异（P = 0.005），但收缩压（r = -0.04，P = 0.49）、舒张压（r = 0.01，P = 0.83）或平均动脉压（r = -0.01，P = 0.84）无差异。接受肠内营养的患者与未接受肠内营养的患者之间的靠背抬高角度无显著差异（P = 0.23），接受间歇性营养与连续性营养的患者之间也无显著差异（P = 0.22）。
较高靠背抬高角度（≥30度）的使用极少，且与肠内营养的使用或血流动力学状态无关。对重症患者采用较低靠背位置的理由可能基于便利性、患者舒适度或病房的常规模式。然而，仰卧位的危险性及其与误吸和呼吸机相关性肺炎的关系不应被忽视。
