机械通气患者早期肺康复治疗的临床观察

关键词：肺康复  机械通气  ICU  撤机

Keywords:pulmonary rehabilitation  mechanical ventilation  ICU  ventilator weaning

摘要：

      摘要 目的：将早期肺康复治疗应用于机械通气72h内的重症患者，观察其对呼吸机的撤离、呼吸机相关肺炎（ventilator associated pneumonia,VAP）发生率、肺部感染严重程度及重症监护病房（intensive care unit, ICU）住院时间的影响。 方法：本研究是一项单中心、观察性、评估者盲法实验，筛选符合研究条件的82例患者，分为试验组和对照组，每组各41例，两组患者均给予ICU常规治疗，试验组患者在常规治疗基础上进行早期肺康复治疗。比较两组患者撤机成功率、VAP发生率、急性生理与慢性健康状况评分Ⅱ (acute physiology and chronic health evaluation, APACHE Ⅱ)、临床肺部感染评分（clinical pulmonary infection score，CPIS）、机械通气时间、ICU住院时间。 结果：两组患者的年龄、性别、诊断及治疗前的APACHEⅡ评分、CPIS评分差异均无显著性意义（P＞0.05）。试验组患者的撤机成功率（87.80%）较对照组显著提高，而VAP发生率（14.63%）明显低于对照组，机械通气时间（6.90±4.61D）和ICU住院时间（12.34±7.23D）较对照组显著缩短（P＜0.05），治疗后试验组CPIS评分明显低于对照组（P＜0.05），差异有显著性意义（P＜0.05）。 结论：早期肺康复治疗可以提高撤机成功率，降低VAP发生率，减轻肺部感染，缩短机械通气持续时间和ICU住院时间。

Abstract:

      Abstract Objective: To investigate if early pulmonary rehabilitation increases the success rate of weaning, the incidence rate of ventilator associated pneumonia (VAP), and the severity of pulmonary infection provided for patients in the ICU (Intensive care unit) receiving mechanical ventilation for less than 72h. Method: The study was a single arm, assessor blinded, observational trial. Eighty-two qualified cases were divided into treatment group (n=41) and control group (n=41). All patients were treated with routine treatment. The treatment group received early pulmonary rehabilitation. APACHE Ⅱ (Acute physiology and chronic health evaluation) and CPIS (clinical pulmonary infection score) scores, the duration of mechanical ventilation, ICU length of stay, the success rate of weaning and the incidence rate of VAP were compared between the two groups. Result: There was no significant difference in age, gender, APACHE Ⅱ score and CPIS score between the two groups before treatment (P＞0.05). Patients in the treatment group presented a significantly higher success rate of weaning (87.80%) and lower incidence of VAP (14.63%) (P＜0.05). The duration of mechanical ventilation and the ICU length of stay were 6.90±4.61 days and 12.34±7.23 days in the treatment group, which were significantly less than those in the control group (P＜0.05). After treatment, the CPIS score was significantly lower than that in the control group (P＜0.05). Conclusion: Early pulmonary rehabilitation can improve the success rate of weaning, reduce the incidence of VAP,the severity of pulmonary infection, the duration of mechanical ventilation,and the ICU length of stay.