早期肺康复对机械通气患者撤机的作用  

Early pulmonary rehabilitation in effect on weaning from patients receiving mechanical ventilation

作　　者：郑丽环[1] 焦清海[1] 刘书花[1] 王健[1] 钱志伟 邢芳远 Zheng Lihuan;Jiao Qinghai;Liu Shuhua;Wang Jian;Qian Zhiwei;Xing Fangyuan(Department of Intensive Care Unit,Handan First Hospital,Handan 056000,China;Department of Respiratory and Critical Care Medicine,Handan First Hospital,Handan 056000,China)

机构地区：[1]邯郸市第一医院重症医学科,邯郸056000 [2]邯郸市第一医院呼吸与危重症医学科,邯郸056000

出　　处：《国际呼吸杂志》2022年第13期997-1002,共6页International Journal of Respiration

基　　金：河北省医学科学研究课题计划(20200189)。

摘　　要：目的探讨有患者家属参与的早期肺康复治疗对ICU机械通气患者撤机的作用。方法本研究为真实验研究。采用随机抽样法纳入2020年6月至2021年12月邯郸市第一医院重症医学科收治的62例机械通气患者,采用随机数字表法分为肺康复组31例和对照组31例。2组患者均给予常规治疗,肺康复组在常规治疗的基础上进行早期肺康复治疗。在肺康复治疗前对患者的1名家属进行培训,在肺康复治疗时,此名患者家属可参与辅助工作。其中肺康复组有4例患者撤机前康复次数<4次,淘汰出组。在试验开始前和撤机前使用床旁超声测量2组患者的膈肌位移,记录此时的呼吸频率,计算出膈肌呼吸浅快指数(DRSBI),记录并比较2组患者谵妄发生率、撤机成功率、机械通气时间、撤机前DRSBI的差异。结果肺康复组患者谵妄发生率22.2%(6/27)较对照组48.4%(15/31)降低,差异有统计学意义(χ^(2)=4.27,P=0.039)。肺康复组患者机械通气时间[125(108,138)h]较对照组[163(117,262)h]缩短,差异有统计学意义(Z=1.79,P=0.037)。肺康复组患者撤机成功率85.2%(23/27)较对照组撤机成功率61.3%(19/31)提高(χ^(2)=4.12,P=0.042);撤机前肺康复组患者DRSBI[11.24(10.29,12.42)次·min^(-1)·mm-1]较对照组[13.25(12.12,19.23)次·min^(-1)·mm-1]减少,差异有统计学意义(Z=2.09,P=0.018)。结论有患者家属参与的早期肺康复治疗可减少患者谵妄发生率,改善机械通气患者膈肌功能,提高撤机成功率,缩短机械通气时间。Objective To explore the effect of early pulmonary rehabilitation participated by patient′s family on weaning from patients receiving mechanical ventilation in intensive care unit(ICU).Methods This is a true experimental study.A total of 62 patients receiving mechanical ventilation in ICU of Handan First Hospital from June 2020 to December 2021 were enrolled by random sampling method,and were divided into rehabilitation group(n=31)and control group(n=31).In basis of conventional treatment,the rehabilitation group was additionally were managed early pulmonary rehabilitation.A trained patient′s family had participated early pulmonary rehabilitation,4 patients in the rehabilitation group were eliminated bue to Number of rehabilitations before weaning<4.The diaphragm displacement was measured by bedside ultrasound before the experiment and before weaning,and respiratory rate was recorded to calculate the diaphragm rapid shallow breathing index(DRSBI).The delirium rate,weaning success rate,the duration of mechanical ventilation,DRSBI before weaning between the two groups were included as comparator.Results The delirium rates in rehabilitation group(22.2%,6/27)were obviously lower than those in control group(48.4%,15/31)(χ^(2)=4.27,P=0.039).The duration of mechanical ventilation was shortened in rehabilitation group vs the control group,with statistically significant difference(125[108,138]h vs 163[117,262]h;Z=1.79,P=0.037,respectively).The weaning success rate in rehabilitation group(85.2%,23/27)was significantly higher relevant to the control group(61.3%,19/31),(χ^(2)=4.12,P=0.042).The difference in DRSBI was statistically significant between the rehabilitation group(11.24[10.29,12.42]time·min^(-1)·mm-1)and the control group(13.25[12.12,19.23]time·min^(-1)·mm-1),(Z=2.09,P=0.018).Conclusions Through the participation of a patient′s family,early pulmonary rehabilitation can decrease delirium rate,improve the diaphragm function,while enhance the weaning success rate and reduce duration of mechanical ventilat

关 键 词：呼吸 人工 康复 谵妄 撤机 膈肌呼吸浅快指数 

分 类 号：R563[医药卫生—呼吸系统] R49[医药卫生—内科学]