基于标准化5问题问卷评分的肺康复计划联合胸腹电刺激在重症卒中机械通气患者中的应用效果  

Application Effect of Pulmonary Rehabilitation Program Based on Standardized Five Questions Score Combined with Thoracoabdominal Electrical Stimulation in Severe Stroke Patients Undergoing Mechanical Ventilation

作　　者：王昱 许勤[2] 许彬 郭川 王协锋 童孜蓉 尹朱丹 WANG Yu;XU Qin;XU Bin;GUO Chuan;WANG Xiefeng;TONG Zirong;YIN Zhudan(Neurosurgical Intensive Care Unit,the First Affiliated Hospital of Nanjing Medical University,Nanjing 210029,China;Nursing School,Nanjing Medical University,Nanjing 211112,China;Rehabilitation Medicine Center,the First Affiliated Hospital of Nanjing Medical University,Nanjing 210029,China)

机构地区：[1]南京医科大学第一附属医院神经外科重症监护室,江苏省南京市210029 [2]南京医科大学护理学院,江苏省南京市211112 [3]南京医科大学第一附属医院康复医学中心,江苏省南京市210029

出　　处：《实用心脑肺血管病杂志》2024年第9期106-110,共5页Practical Journal of Cardiac Cerebral Pneumal and Vascular Disease

基　　金：国家重点研发计划项目(2022YFC2009700,2022YFC2009701);国家自然科学基金资助项目(82172667,82302882);临床能力提升工程护理项目(JSPH-NC-2022-21)。

摘　　要：目的探讨基于标准化5问题问卷(S5Q)评分的肺康复计划联合胸腹电刺激在重症卒中机械通气患者中的应用效果。方法选取2021年2月—2023年1月南京医科大学第一附属医院神经外科重症监护室(NICU)收治的重症卒中机械通气患者60例,采用随机数字表法将其分为对照组和观察组,每组30例。两组患者均接受NICU的常规治疗、常规护理及基于S5Q评分的肺康复计划,在此基础上,对照组患者接受胸腹假刺激干预,观察组患者接受胸腹电刺激干预。干预时间从机械通气48 h开始至脱离呼吸机。比较两组患者干预前及干预后第7天病情严重程度指标[急性生理学与慢性健康状况评价系统Ⅱ(APACHEⅡ)评分、临床肺部感染评分(CPIS)、颅内压],机械通气时间、NICU住院时间,干预前及干预后第7天胸腹肌肉厚度[胸部肌肉厚度(CT)和腹部肌肉厚度(AT)]、呼吸功能指标[动态肺顺应性、呼气末二氧化碳分压(ETCO_(2))、氧合指数(OI)]、炎症指标[白细胞计数、C反应蛋白(CRP)及外周血单个核细胞(PBMC)中Th1细胞、Th2细胞比例]。结果干预后第7天,两组患者APACHEⅡ评分、CPIS分别低于本组干预前,且观察组低于对照组(P<0.05)。观察组患者机械通气时间、NICU住院时间短于对照组(P<0.05)。干预后第7天,对照组患者CT、AT小于本组干预前,且观察组患者CT、AT大于对照组(P<0.05)。干预后第7天,两组患者动态肺顺应性分别大于本组干预前,ETCO_(2)、OI分别高于本组干预前(P<0.05);干预后第7天,观察组患者动态肺顺应性大于对照组,ETCO_(2)、OI高于对照组(P<0.05)。干预后第7天,两组患者白细胞计数、CRP及PBMC中Th1细胞比例分别低于本组干预前,PBMC中Th2细胞比例分别高于本组干预前(P<0.05);干预后第7天,观察组患者白细胞计数、CRP及PBMC中Th1细胞比例低于对照组,PBMC中Th2细胞比例高于对照组(P<0.05)。结论基于S5Q评分的肺康复计划联�Objective To explore the application effect of pulmonary rehabilitation program based on Standardized Five Questions(S5Q)score combined with thoracoabdominal electrical stimulation in severe stroke patients undergoing mechanical ventilation.Methods From February 2021 to January 2023,60 cases severe stroke patients undergoing mechanical ventilation admitted to the Neurosurgery Intensive Care Unit(NICU)of the First Affiliated Hospital of Nanjing Medical University were selected and divided into control group and observation group by random number table method,with 30 cases in each group.Patients in both groups received routine treatment,routine nursing and pulmonary rehabilitation program based on S5Q score in NICU.On this basis,patients in the control group received thoracoabdominal sham stimulation intervention,and patients in the observation group received thoracoabdominal electrical stimulation intervention.The intervention time was from 48 h of mechanical ventilation to weaning from ventilator.The disease severity indexes[Acute Physiology and Chronic Health EvaluationⅡ(APACHEⅡ)score,Clinical Pulmonary Infection Score(CPIS),intracranial pressure]before intervention and on the 7th day after intervention,mechanical ventilation time and NICU hospitalization time,chest abdominal muscle thickness[chest muscle thickness(CT)and abdominal muscle thickness(AT)],respiratory function indexes[dynamic lung compliance,end-tidal carbon dioxide partial pressure(ETCO_(2)),oxygenation index(OI)],inflammation indexes[white blood cell count,C-reactive protein(CRP)and the proportion of Th1 cells and Th2 cells in peripheral blood mononuclear cells(PBMC)]before intervention and on the 7 th day after intervention were compared between the two groups.Results On the 7th day after intervention,the APACHEⅡscore and CPIS in the two groups were lower than those before intervention respectively,and those in the observation group were lower than those in the control group(P<0.05).The mechanical ventilation time and NICU hospitalization

关 键 词：卒中 呼吸 人工 标准化5问题问卷 肺康复 胸腹电刺激 

分 类 号：R743[医药卫生—神经病学与精神病学]