基于预康复理念的心脏围手术期肺康复体系对术后早期拔除气管插管的影响  

Influence of perioperative pulmonary rehabilitation system based on prehabilitation on early weaning during cardiac perioperative period

作　　者：叶家欣[1] 陈涛[1] 陈成[1] 陆利冲[1] 王志刚 程永庆 王哲芸 槐洪波 葛敏[1] 王东进 Ye Jiaxin;Chen Tao;Chen Cheng;Lu Lichong;Wang Zhigang;Cheng Yongqing;Wang Zheyun;Huai Hongbo;Ge Min;Wang Dongjin(Cardiac Surgery Intensive Care Unit,Nanjing Drum Tower Hospital,Affiliated Hospital of Nanjing University Medical School,Nanjing Drum Tower Hospital Clinical College of Nanjing Medical University,Nanjing 210008,China;Department of Rehabilitation Medicine,Nanjing Drum Tower Hospital,Affiliated Hospital of Nanjing University Medical School,Nanjing Drum Tower Hospital Clinical College of Nanjing Medical University,Nanjing 210008,China;Department of Cardiothoracic Surgery,Nanjing Drum Tower Hospital,Affiliated Hospital of Nanjing University Medical School,Nanjing Drum Tower Hospital Clinical College of Nanjing Medical University,Nanjing 210008,China)

机构地区：[1]南京医科大学附属鼓楼临床学院,南京大学医学院附属鼓楼医院心外科重症监护,210008 [2]南京医科大学附属鼓楼临床学院,南京大学医学院附属鼓楼医院康复医学科,210008 [3]南京医科大学附属鼓楼临床学院,南京大学医学院附属鼓楼医院心胸外科,210008

出　　处：《中华胸心血管外科杂志》2021年第8期496-501,共6页Chinese Journal of Thoracic and Cardiovascular Surgery

基　　金：国家自然科学基金(8197020891);中国博士后科学基金第65批面上资助(2019M651804);中央高校基本科研业务费专项资金资助(214-14380488);江苏省十三五科教强卫工程医学重点学科(ZDXKA2016019);南京市卫生青年人才计划项目(QRX17131)。

摘　　要：目的评估基于预康复理念的心脏外科手术围手术期肺康复体系对术后拔除气管插管(拔管)和避免相关肺部并发症的临床效果。方法纳入2018年1月至2019年12月期间432例术前住院7天行直视心脏手术的成年患者,数字表法随机分为肺康复组(198例)和对照组(234例)。比较两组整体结局指标(包括早期拔管率、ICU停留时间、拔管后高级氧疗支持等)和肺部结局指标(包括肺部并发症、胸腔引流、二次插管等)。结果两组间术前基础指标和手术情况差异无统计学意义(P>0.05)。肺康复组早期拔管率显著提高、拔管后高级氧疗患者减少,ICU住院时间缩短,医疗费用减少,术后肺部并发症减少,术后呼吸功能改善(P<0.05)。结论建立和实施肺康复体系可提高心外科围手术期早期拔管率,显著缩短机械通气时间,减少二次插管和肺部并发症发生,促进围手术期肺部康复,改善患者整体康复。Objective To evaluate the clinical effect of the pulmonary rehabilitation system based on the concept of prehabilitation for patients after cardiac surgery to wean tube and avoid related complications.Methods From January 2018 to December 2019 in a single-center(third-class hospital in cardiac surgery intensive care unit),all adult patients hospitalized for 7 days before open-heart surgery were included.They were randomly divided into pulmonary rehabilitation group(198 cases)and control group(234 cases).To compare and analyze the clinical effects,the main observations were observed including overall outcome indicators(such as early extubation rate,ICU stay,hospitalization costs,advanced oxygen therapy support after extubation)and lung outcome related indicators(such as the occurrence of pulmonary complications,chest drainage,secondary intubation,tracheotomy,lung infection and chest tube drainage).Results There was no statistical difference between groups in basic conditions and surgical conditions.The lung rehabilitation group significantly increased the rate of early extubation,reduced the number of advanced oxygen therapy after weaning,shortened the length of ICU stay,saved hospitalization cost,significantly reduced the occurrence of postoperative respiratory complications and improved postoperative respiratory function(P<0.05).Conclusion During cardiac perioperation,pulmonary rehabilitation significantly can increase the rate of early extubation,shorten the length of mechanical ventilation,reduce the occurrence of secondary tracheal intubation and pulmonary complications.And it can also effectively promote the recovery of lung function and the overall recovery.

关 键 词：肺康复体系 预康复 心脏外科手术 早拔管策略 快速康复外科 

分 类 号：R473.6[医药卫生—护理学]