机械通气患者早期肺康复分级方案的构建与应用研究

doi:10.3761/j.issn.0254-1769.2020.08.001

摘要/Abstract

摘要：

目的构建机械通气患者早期肺康复分级方案并探讨其临床应用效果。方法运用德尔菲法构建机械通气患者早期肺康复分级方案,选取2019年1月—12月在安徽省某三级甲等医院ICU收治的100例机械通气患者为研究对象,随机分为试验组和对照组各50例,试验组采用早期肺康复分级方案,对照组采用常规康复治疗护理,比较两组在氧合指数、血二氧化碳分压、乳酸值、急性生理与慢性健康状况评分、临床肺部感染评分、撤机成功率、病死率、机械通气时间、ICU住院时间及呼吸机相关性肺炎、谵妄、压力性损伤、深静脉血栓等并发症的差异。结果肺康复第3、5、7、14天试验组氧合指数显著高于对照组,肺康复第7天试验组血二氧化碳分压、乳酸值、急性生理与慢性健康状况评分、临床肺部感染评分显著低于对照组,试验组呼吸机相关性肺炎、深静脉血栓、病死率、机械通气时间、ICU住院时间显著低于对照组,撤机成功率显著高于对照组,均P<0.05。结论应用早期肺康复分级方案可改善机械通气患者呼吸功能和疾病预后,缩短机械通气时间和ICU住院时间,减少并发症的发生。

关键词: 重症监护病房, 肺康复, 机械通气, 康复护理

Abstract:

Objective To construct an early pulmonary rehabilitation grading scheme for patients with mechanical ventilation,and to explore effects of its application. Methods The Delphi method was used to construct an early pulmonary rehabilitation grading scheme for patients with mechanical ventilation. 100 patients with mechanical ventilation were selected as research subjects from January to December 2019,and they were randomly allocated into a rehabilitation group and a conventional group with 50 cases in each group. The conventional group adopted the conventional rehabilitation treatment and nursing care,while the rehabilitation group adopted an early pulmonary rehabilitation grading scheme. The differences in oxygenation index,partial blood carbon dioxide pressure,lactic acid value,acute physiology and chronic health evaluation,clinical pneumonia infection score,success rate of withdrawal,mortality,duration of mechanical ventilation,length of ICU stay,and ventilator-associated pneumonia,delirium,pressure ulcers,deep vein thrombosis and other complications between 2 groups were compared. Results On the 3rd,5th,7th,and 14th day of pulmonary rehabilitation,the oxygenation index of the rehabilitation group was significantly higher than that of the conventional group. On the 7th day of pulmonary rehabilitation,the partial blood carbon dioxide pressure,lactic acid value,acute physiology and chronic health evaluation,clinical pneumonia infection score in the rehabilitation group were significantly lower than those in the conventional group. The incidence of ventilator-associated pneumonia,deep venous thrombosis,death rate,duration of mechanical ventilation,length of ICU stay in the rehabilitation group were significantly lower than those in the conventional group. The withdrawal success rate in the rehabilitation group was significantly higher than that in the conventional group（all P values<0.05）. Conclusion The application of the early pulmonary rehabilitation grading scheme can improve the respiratory function and disease prognosis for patients with mechanical ventilation,shorten the time of mechanical ventilation and the length of ICU hospitalization,and reduce the occurrence of complications.

Key words: Intensive Care Units, Pulmonary Rehabilitation, Mechanical Ventilation, Rehabilitation Nursing

汪璐璐, 徐凤玲, 刘钢, 朱瑞, 胡少华, 邵敏, 于犇犇. 机械通气患者早期肺康复分级方案的构建与应用研究[J]. 中华护理杂志, 2020, 55(8): 1125-1132.

WANG Lulu, XU Fengling, LIU Gang, ZHU Rui, HU Shaohua, SHAO Min, YU Benben. Construction and preliminary application of early pulmonary rehabilitation grading scheme for patients with mechanical ventilation[J]. Chinese Journal of Nursing, 2020, 55(8): 1125-1132.

图/表 5

表1 机械通气患者早期肺康复分级方案

表2 两组一般资料比较

表3 两组不同时间氧合指数比较（mmHg,$\bar{x}±s$）

表4 两组干预前后动脉血气分析指标、急性生理与慢性健康评分、临床肺部感染评分比较（$\bar{x}±s$）

表5 两组干预后并发症发生率、撤机成功率、病死率、机械通气时间、ICU住院时间比较

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