早期运动治疗对慢性阻塞性肺疾病机械通气患者胃肠功能和呼吸力学影响的前瞻性随机对照研究  

A prospective randomized controlled study on the effects of early mobilization therapy on gastrointestinal function and respiratory mechanics in mechanical ventilation patients with chronic obstructive pulmonary disease

作　　者：刘景刚[1] 孟素秋[1] 张贵真 袁继印 刘继华[1] 杨圣强[1] Liu Jinggang;Meng Suqiu;Zhang Guizhen;Yuan Jiyin;Liu Jihua;Yang Shengqiang(artment of Intensive Care Unit, Affiliated Huxi Hospital of Jining Medical College （Shanxian Central Hospital）, Shandong Shanxian 274300, Chin)

机构地区：[1]济宁医学院附属湖西医院(山东省单县中心医院)重症医学科,274300

出　　处：《中国医师进修杂志》2018年第7期600-605,共6页Chinese Journal of Postgraduates of Medicine

基　　金：山东省医药卫生科技发展计划（2015WS0467）

摘　　要：目的探讨早期运动治疗对慢性阻塞性肺疾病（COPD）机械通气患者胃肠功能和呼吸力学的影响。方法采用前瞻性随机对照研究方法，纳入2017年1—12月收治的血流动力学稳定、需要有创机械通气的COPD患者85例，按照随机数字表法分为治疗组43例和对照组42例。两组患者均给予常规基础治疗，但治疗组给予早期运动治疗。比较两组患者急性胃肠损伤（AGI）情况、呼吸机相关肺炎（VAP）发生率、机械通气时间、28 d病死率及治疗前后呼吸力学指标[气道阻力（Raw）、肺动态顺应性（Cd）、肺静态顺应性（Cs）、内源性呼气末正压（PEEPi）]。结果两组治疗前Raw、Cd、Cs和PEEPi比较差异无统计学意义（P〉0.05）。治疗后治疗组PEEPi和Raw明显低于对照组[（6.51 ± 1.46）cmH2O（1 cmH2O= 0.098 kPa）比（7.30 ± 1.61）cmH2O和（19.23 ± 2.62）cmH2O/（L·s）比（20.54 ± 2.50）cmH2O/（L·s）]，Cs和Cd明显高于对照组[（53.14 ± 5.07）ml/cmH2O比（49.16 ± 5.10）ml/cmH2O和（26.63 ± 3.28）ml/cmH2O比（24.54 ± 1.97）ml/cmH2O]，差异有统计学意义（P〈0.05或〈0.01）。治疗组AGI发生率、AGI持续时间、机械通气时间和VAP发生率明显低于对照组[44.2%（19/43）比66.7%（28/42）、（3.56 ± 1.22）d比（4.26 ± 1.62）d、（6.79 ± 1.92）d比（7.64 ± 1.89）d和2.3%（1/43）比14.3%（6/42）]，AGI严重程度明显低于对照组（治疗组Ⅰ、Ⅱ、Ⅲ和Ⅳ级患者分别为11、6、1和1例，对照组分别为7、12、8和1例），差异有统计学意义（P〈0.05）。两组28 d病死率比较差异无统计学意义（P〉0.05）。结论COPD机械通气患者的AGI发生率高。早期运动治疗能够减少COPD机械通气患者AGI的发生率和持续时间，能够降低其气道阻力，增加Cd和Cs，降低PEEPi，改善呼吸功能，缩短机械通气时间，降低VAP发生率，值得临床推广。ObjectiveTo investigate the effects of early mobilization therapy on gastrointestinal function and respiratory mechanics in mechanical ventilation patients with chronic obstructive pulmonary disease （COPD）.MethodsA prospective randomized controlled study was used. Eighty-five patients with COPD who had stable hemodynamics and required invasive mechanical ventilation from January to December 2017 were enrolled. The patients were divided into treatment group with 43 cases and control group with 42 cases according to the random number table method. The patients in both groups received conventional basic treatment, but the treatment group received early mobilization therapy. The conditions of acute gastrointestinal injury （AGI）, incidence of ventilator-associated pneumonia （VAP）, duration of mechanical ventilation, 28-day mortality and respiratory mechanics indexes before and after treatment including airway resistance （Raw）, lung dynamic compliance （Cd）, lung static compliance （Cs）, intrinsic positive end expiratory pressure （PEEPi） were compared between 2 groups.ResultsThere were no statistical difference in Raw, Cd, Cs and PEEPi before treatment between 2 groups （P〉0.05）. The PEEPi and Raw after treatment in treatment group were significantly lower than those in control group： （6.51 ± 1.46） cmH2O （1 cmH2O= 0.098 kPa） vs. （7.30 ± 1.61） cmH2O and （19.23 ± 2.62） cmH2O/（L·s） vs. （20.54 ± 2.50） cmH2O/（L·s）, the Cs and Cd were significantly higher than those in control group： （53.14 ± 5.07） ml/cmH2O vs. （49.16 ± 5.10） ml/cmH2O and （26.63 ± 3.28） ml/cmH2O vs. （24.54 ± 1.97） ml/cmH2O, and there were statistical differences （P〈0.05 or〈0.01）. The incidences of AGI, duration of AGI, duration of mechanical ventilation and incidence of VAP in treatment group were significantly lower than those in control group： 44.2% （19/43） vs. 66.7% （28/42）, （3.56 ± 1.22） d vs. （4.26 ± 1.62） d, （6.79 ± 1.92） d vs. （7

关 键 词：肺疾病 慢性阻塞性 呼吸 人工 运动疗法 呼吸力学 前瞻性研究 

分 类 号：R563.9[医药卫生—呼吸系统]