早期活动在重症监护室老年慢性阻塞性肺疾病合并肺部感染机械通气患者中的应用观察  

Application of early activity in elderly patients with chronic obstructive pulmonary disease and pulmonary infection undergoing mechanical ventilation in ICU

作　　者：乔红 赵明凤 任尧 姜亚娟 赵莹 李妍 Qiao Hong;Zhao Mingfeng;Ren Yao;Jiang Yajuan;Zhao Ying;Li Yan(Department of Emergency and Critical Care Medicine,First Affiliated Hospital of Nanjing Medical University,Nanjing,Jiangsu,210029,P.R.China)

机构地区：[1]南京医科大学第一附属医院急诊与危重症医学科,江苏南京210029

出　　处：《老年医学与保健》2024年第3期768-773,共6页Geriatrics & Health Care

摘　　要：目的观察早期活动在重症监护室(ICU)老年慢性阻塞性肺疾病(COPD)合并肺部感染机械通气患者中的应用情况。方法选取2022年4月—2023年5月南京医科大学第一附属医院收治的ICU老年COPD合并肺部感染机械通气的患者80例,采用随机数字表法分为观察组和对照组,每组40例。对照组采用常规护理干预,观察组在与对照组相同干预的基础上加用早期活动干预,2组患者均干预7 d,观察并比较2组住院情况、日常生活活动能力、呼吸力学压力指标值、生命体征相关指标值及不良事件发生情况。结果观察组机械通气时间、入住ICU时间均少于对照组,谵妄发生率低于对照组(均P<0.05)。干预后,2组改良Barthel指数评分较同组干预前升高,观察组各项评分均高于对照组(均P<0.05);2组呼吸力学压力指标值较同组干预前下降,观察组呼吸力学压力指标值低于对照组(均P<0.05);2组急性生理和慢性健康(APACHEⅡ)评分、体温较同组干预前下降,氧合指数较同组干预前上升,观察组APACHEⅡ评分低于对照组,氧合指数高于对照组(均P<0.05),而2组体温差异无统计学意义(P>0.05);观察组治疗不良反应发生率低于对照组(2.50%vs 15.00%,P<0.05)。结论对ICU老年COPD合并肺部感染机械通气患者进行早期活动干预,可能缩短机械通气时间与入住ICU时间、减少谵妄发生情况、降低不良事件发生率、提升患者日常生活活动能力、促进呼吸力学系统恢复,具有一定的临床应用价值。Objective To explore the application of early activity in elderly patients with chronic obstructive pulmonary disease(COPD)and pulmonary infection undergoing mechanical ventilation in the intensive care unit(ICU).Methods 80 elderly patients with COPD and pulmonary infection who underwent mechanical ventilation in ICU of First Affiliated Hospital of Nanjing Medical University from April 2022 to May 2023 were selected and divided into observation group and control group by random number table method,with 40 cases in each group.The control group received routine nursing intervention,while the observation group received early activity intervention in addition to the same intervention as the control group.Both groups were intervened for 7 days.The hospitalization conditions,activities of daily living,respiratory pressure indexes,vital signs related indexes and adverse events were observed and compared between the two groups.Results The mechanical ventilation time and ICU stay time in the observation group were shorter than those of the control group,and the incidence of delirium was lower than that in the control group(all P<0.05).After intervention,the modified Barthel index scores of the two groups were higher than those of the same group before intervention,and the observation group was higher than the control group(all P<0.05);the respiratory pressure index values of the two groups were lower than those of the same group before intervention,and the observation group was lower than the control group(both P<0.05);the Acute Physiological and Chronic Health(APACHEⅡ)scores and body temperature of the two groups were lower than those of the same group before intervention,and the oxygenation index(OI)were higher than those of the same group before intervention,while the APACHEⅡ score of the observation group was lower than that of the control group,and OI was higher than that of the control group(both P<0.05),but there was no statistically significant difference in body temperature between the two groups(P>0.05).The

关 键 词：老年 慢性阻塞性肺疾病 重症监护室 肺部感染 机械通气 早期活动 

分 类 号：R563[医药卫生—呼吸系统]