早期中西医肺康复在脑出血术后有创机械通气患者中的应用研究  

Application of an early pulmonary rehabilitation of traditional Chinese and Western medicine to patients with invasive mechanical ventilation after cerebral hemorrhage surgery

作　　者：米娇 郑旭银 张娟娟 李雪 袁榕[1] MI Jiao;ZHENG Xu-yin;ZHANG Juan-juan;LI Xue;YUAN Rong

机构地区：[1]德阳市人民医院神经重症监护室,四川德阳618000 [2]粤北人民医院重症医学科,广东韶关512000 [3]深圳市人民医院心血管内科监护室,广东深圳518000

出　　处：《中国疗养医学》2025年第1期60-64,共5页Chinese Journal of Convalescent Medicine

基　　金：2023年四川护理职业学院自然科学课题资助(2023ZRY24)。

摘　　要：目的探讨早期中西医肺康复方案在脑出血术后有创机械通气患者中的应用效果。方法采用便利抽样法选取2023年10月至2024年7月德阳市某三级甲等医院神经重症监护室(NCU)的80例脑出血术后行有创机械通气的患者作为研究对象,以2023年10月至2024年2月收治的40例患者为对照组,以2024年3月至7月收治的40例患者为试验组,对照组实施神经重症常规肺康复治疗,试验组在神经重症常规肺康复治疗的基础上实施早期中西医肺康复方案。比较干预前、干预后第3、5、10天两组患者的动脉血氧分压[p(O_(2))]、二氧化碳分压[p(CO_(2))]、氧合指数、肺炎严重指数和APACHEⅡ评分以及患者机械通气时长、成功撤机率和呼吸机相关性肺炎(VAP)发生率的情况。结果试验组的VAP发生率和有创机械通气时长明显低于对照组(P<0.05),成功撤机率高于对照组(P<0.05)。干预前,动脉p(O_(2))、p(CO_(2))、氧合指数、肺炎严重指数和APACHEⅡ得分比较,差异均无统计学意义(P>0.05)。干预后试验组的p(O_(2))、氧合指数总体高于对照组且呈上升趋势(P<0.01),p(CO_(2))低于对照组(P<0.01);两组患者的p(CO_(2))(F=3.108,P=0.036)、氧合指数(F=5.432,P=0.020)的差异随时间变化而明显增大。干预后试验组肺炎严重指数低于对照组且呈下降趋势(P<0.01),APACHEⅡ评分总体高于对照组且呈下降趋势(P<0.05);两组患者的APACHEⅡ评分(F=15.276,P<0.01)的差异随时间变化而明显增大。结论早期中西医肺康复方案有利于降低脑出血术后有创机械通气患者呼吸机相关性肺炎的发生率和有创机械通气时长,提高成功撤机率,改善预后。Objective To explore the application effect of an early pulmonary rehabilitation of traditional Chinese and Western medicine to patients with invasive mechanical ventilation after cerebral hemorrhage surgery.Methods Convenience sampling method was used to select 80 patients with invasive mechanical ventilation after cerebral hemorrhage surgery in the neurological intensive care unit(NCU)of a ClassⅢGrade A hospital in Deyang from October 2023 to July 2024 as the research object,including 40 patients admitted from October 2023 to February 2024 as the control group,and 40 patients admitted from March 2024 to July 2024 in the experimental group.The control group was given routine pulmonary rehabilitation treatment,and the experimental group was given an early pulmonary rehabilitation of traditional Chinese and Western medicine plus routine pulmonary rehabilitation treatment.Partial pressure of oxygen[p(CO_(2))],partial pressure of carbon dioxide[p(CO_(2))],oxygenation index,pneumonia severity index and the Acute Physiology and Chronic Health EvaluationⅡ(APACHEⅡ),duration of mechanical ventilation,weaning proportion,incidence of ventilator-associated pneumonia(VAP)before and 3,5 and 10 days after the intervention were compared.Results The incidence of VAP and the duration of invasive mechanical ventilation in the experimental group were significantly lower than those in the control group(P<0.05),and the weaning proportion was significantly higher than that in the control group(P<0.05).Before the intervention,there were no significant differences in p(O_(2)),p(CO_(2)),oxygenation index,pneumonia severity index and APACHEⅡscore(P>0.05).After intervention,p(O_(2))and oxygenation index of the experimental group were significantly higher than those of the control group and showed an overall upward trend(P<0.01),and p(CO2)was significantly lower than that of the control group(P<0.01).The differences in p(CO2)(F=3.108,P=0.036)and oxygenation index(F=5.432,P=0.020)between the two groups increased significantly with ti

关 键 词：脑出血术后 早期肺康复 有创机械通气 

分 类 号：R651.1[医药卫生—外科学] R493[医药卫生—临床医学]