早期活动对慢性阻塞性肺疾病机械通气患者胃肠功能及谵妄的影响  

Effect of early mobilization on gastrointestinal function and delirium in patients with mechanical ventilation of chronic obstructive pulmonary disease

作　　者：刘景刚[1] 张贵真 陈爽 孟素秋[1] 刘继华[1] 杨圣强[1] Liu Jinggang;Zhang Guizhen;Chen Shuang;Meng Suqiu;Liu Jihua;Yang Shengqiang(Department of Intensive Care Unit ,Huxi Hospital Affiliated to Jining Medical College, the Central Hospital of Shanxian County, Heze, Shandong 274300, China)

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：《中国基层医药》2019年第17期2057-2060,共4页Chinese Journal of Primary Medicine and Pharmacy

基　　金：山东省医药卫生科技发展计划项目(2015WS0467).

摘　　要：目的探讨早期活动对慢性阻塞性肺疾病(COPD)机械通气患者胃肠功能及谵妄的影响.方法选择济宁医学院附属湖西医院重症医学科2017年4月至2018年3月收治的符合纳入标准的COPD机械通气患者87例为研究对象,采用随机数字表法分为治疗组44例、对照组43例.在相同常规治疗的基础上,治疗组进行早期活动.比较两组急性胃肠损伤(AGI)发生率、AGI持续时间、谵妄发生率、谵妄持续时间、机械通气天数、28 d病死率.结果治疗组AGI发生率低于对照组[40.9%(18/44)比62.7%(27/43)]、AGI持续时间短于对照组[(3.95±1.62)d比(5.23±2.03)d]、谵妄发生率低于对照组[54.5%(24/44)比76.7%(33/43)]、谵妄持续时间短于对照组[(2.36±0.9)d比(3.25±1.27)d]、机械通气时间短于对照组[(6.39±1.76)比(7.56±1.49)d],差异均有统计学意义(x2=4.170,t=-2.280,x2=4.744,t=-2.919、-3.358,均P<0.05);两组患者28 d病死率[2.3%(1/43)比9.3%(4/43)]差异无统计学意义(x2=-1.984,P>0.05).结论早期活动能够减少COPD机械通气患者AGI和谵妄的发生率并缩短持续时间,降低AGI严重程度,缩短机械通气时间.Objective To investigate the effect of early mobilization on gastrointestinal function and delirium in patients with mechanical ventilation of chronic obstructive pulmonary disease ( COPD ). Methods A total of 87 mechanically ventilated patients with COPD who met the inclusion criteria were selected as subjects from April 2017 to March 2018 in intensive care unit( ICU) of Huxi Hospital Affiliated to Jining Medical College. The patients were divided into treatment group (44 cases) and control group (43 cases) by the random number table method. On the basis of the same conventional treatment, the treatment group received early mobilization. The incidence of acute gastrointestinal injury ( AGI), duration of AGI, incidence of delirium, duration of delirium, days of mechanical ventilation and 28 - day mortality were compared between the two groups. Results The incidence rate of AGI in the treatment group was lower than that in the control group[40. 9%(18/44) vs. 62. 7%(27/43 )],and the duration in the treatment group was shortened[(3. 95 ± 1.62)d vs.(5.23 ±2. 03)d],and the incidence rate of delirium in the treatment group was lower[54. 5%(24/44) vs. 76. 7%( 33/43 )], the duration of delirium in the treatment group was shortened[(2. 36 ±0. 9) d vs.( 3. 25 ± 1.27 ) d], the mechanical ventilation time in the treatment group was decreased[(6. 39 ± 1.76) d vs.(7. 56 ± 1.49)d],the differences were statistically significant(χ^2=4.17,t =-2.280, χ^2 =4.744,t =-2.919,-3. 358 ,all P <0. 05). There was no statistically significant difference in the rate of 28 - day mortality between the two groups[2. 3%(1/43) vs. 9. 3%(4/43),χ^2 =- 1.984,P >0.05]. Conclusion Early mobilization can reduce the incidence and duration of AGI and delirium in COPD patients with mechanical ventilation ,reduce the severity of AGI, and shorten the time of mechanical ventilation.

关 键 词：肺疾病 慢性阻塞性 呼吸 人工 通气机 机械 早日下床活动 胃肠活动 请妄 

分 类 号：R563.9[医药卫生—呼吸系统]