早期康复训练对机械通气重症脑卒中患者的影响

关键词：早期移动  呼吸训练  机械通气  重症  脑卒中  康复

Keywords:early mobilisation  respiratory training  mechanical ventilation  critical illness  stroke  rehabilitation

摘要：

      摘要 目的：探讨早期康复训练对机械通气重症脑卒中患者功能改善的影响。 方法：将50例带有机械通气的重症脑卒中患者按随机字数表法分为试验组和对照组，每组各25例。两组患者均接受神经科ICU常规药物治疗和常规护理，试验组在此基础上进行早期康复训练，包括肢体运动和呼吸训练，2次/d。比较两组患者治疗前后急性生理与慢性健康状况评分Ⅱ（acute physiology and chronic health evaluation， APACHE Ⅱ），以及呼吸机相关肺炎（ventilator associated pneumonia， VAP）发生率、撤机成功率、机械通气时间和ICU住院时间。 结果：①治疗前两组患者APACHE Ⅱ评分比较，差异无显著性意义（P＞0.05）；②治疗后，两组患者APACHE Ⅱ评分与治疗前比较均明显降低（P＜0.01），但组间差异无显著性意义（P＞0.05）；③治疗后试验组VAP发生率明显低于对照组，而撤机成功率显著高于对照组，机械通气时间和ICU住院时间明显短于对照组（P＜0.05）。 结论：早期肢体运动和呼吸训练可以提高机械通气重症脑卒中患者的撤机成功率，降低VAP发生率，缩短机械通气时间和ICU住院时间。

Abstract:

      Abstract Objective： To investigate the effects of early mobilisation and rehabilitation on mechanically ventilated critically ill patients with stroke. Method： Fifty critical stroke patients with mechanical ventilation were randomly divided into experimental (n=25) and control group (n=25). All patients received routine medication and nursing in neurological ICU. In addition， the experimental group was treated with early mobilisation and rehabilitation (including respiratory training twice a day. Acute physiology and chronic health evaluation (APACHE Ⅱ) scores， the incidence of ventilator associated pneumonia (VAP)， the success rate of ventilator weaning， the duration of mechanical ventilation and length of ICU stay were compared between two groups. Result： ①There were no significant differences in APACHE Ⅱ score， between the two groups before treatment(P＞0.05). ②After treatment， the APACHE Ⅱ score in the two groups were significantly lower than those before treatment(P＜0.01)， but there was no significant difference between the two groups(P＞0.05). ③The treatment group patients presented a significantly lower incidence of VAP and higher success rate of ventilator weaning，and（d） the duration of mechanical ventilation and length of ICU stay were significantly less than those in the control group(P＜0.05). Conclusion： Early mobilisation and respiratory training can improve the success rate of ventilator weaning of mechanically ventilated critically ill patients with stroke， and reduce the incidence of VAP， the duration of mechanical ventilation and ICU stay length.