肺结核有创机械通气患者肺康复联合早期活动方案的效果分析  

Effectiveness of pulmonary rehabilitation combined with early mobilization program in patients with pulmonary tuberculosis receiving invasive mechanical ventilation

作　　者：玉明柳 龚贝贝[2] 陈跃华[1] 蓝伟恩 韦海明 甘霖[1] 陈向斓 Yu Mingliu;Gong Beibei;Chen Yuehua;Lan Weien;Wei Haiming;Gan Lin;Chen Xianglan(Intensive Care Unit,Nanning Fourth People’s Hospital,Nanning 530023,China;Nursing Department,Nanning Fourth People’s Hospital,Nanning 530023,China)

机构地区：[1]南宁市第四人民医院重症医学科,南宁530023 [2]南宁市第四人民医院护理部,南宁530023

出　　处：《结核与肺部疾病杂志》2025年第2期217-224,共8页Journal of Tuberculosis and Lung Disease

基　　金：广西壮族自治区卫生健康委员会自筹经费科研课题(Z20200268)。

摘　　要：目的:构建肺结核有创机械通气患者肺康复联合早期活动方案并观察应用效果。方法:采用回顾性队列研究设计,按照入组标准选择2021年1—12月南宁市第四人民医院重症医学科收治的53例肺结核有创机械通气患者作为对照组,给予常规方法护理;2022年1—12月收治的54例肺结核有创机械通气患者作为观察组,在对照组护理基础上实施以肺康复联合早期活动方案的干预,由呼吸治疗师为主导的肺康复小组全程指导进行四级肺康复联合早期活动。对两组患者呼吸机相关性肺炎(VAP)发生率,并发谵妄率,病亡率,ICU住院时间,肺康复后第1、8天的氧合指数,撤机成功率,压力性损伤发生率,深静脉血栓形成发生率,ICU住院费用,肺康复联合早期活动过程中不良事件发生率和训练依从性进行对比分析。结果:观察组机械通气的持续时间[(6.22±2.30)d]、ICU住院时间[(9.20±1.55)d]、ICU住院费用[49835.46(32178.02,75958.55)元]均低于对照组[分别为(15.60±5.00)d、(17.23±5.23)d、91061.00(75433.83,122598.44)元],VAP的发生率[0.0%(0/54)]、谵妄发生率[5.6%(3/54)]、压力性损伤发生率[0.0%(0/54)]、深静脉血栓发生率[1.9%(1/54)]、撤机成功率[98.1%(53/54)]、病亡率[3.7%(2/54)]、肺康复后第8天的氧合指数[(331.31±134.35)mmHg]均优于对照组[分别为11.3%(6/53)、20.8%(11/53)、9.4%(5/53)、13.2%(7/53)、77.4%(41/53)、20.8%(11/53)、(276.31±80.25)mmHg],差异均有统计学意义(t=―12.431,P<0.001;t=―10.721,P<0.001;Z=―5.499,P<0.001;χ^(2)=6.476,P=0.013;χ^(2)=4.179,P=0.041;χ^(2)=5.344,P=0.027;χ^(2)=4.364,P=0.037;χ^(2)=10.831,P=0.001;χ^(2)=5.776,P=0.016;t=2.790,P=0.008);观察组肺康复前氧合指数[(209.21±87.92)mmHg]和肺康复联合早期活动后第1天的氧合指数[(245.88±126.85)mmHg]、不良事件发生率(33.3%,18/54)、肺康复训练依从性(85.2%,46/54)与对照组[分别为(197.54±79.10)mmHg、(232.20±120.01)mmHg、18.9%(10/53)、90.6%(48/53)]比Objective:To establish and evaluate the clinical effect of a pulmonary rehabilitation combined with early mobilization program in patients with pulmonary tuberculosis(PTB)receiving invasive mechanical ventilation.Methods:A retrospective cohort study was conducted.According to inclusion criteria,53 PTB patients admitted to the ICU of Nanning Fourth People’s Hospital from January to December 2021 were selected as control group and received routine nursing care.From January to December 2022,54 PTB patients were enrolled as observation group and received pulmonary rehabilitation combined with early mobilization program,guided by a multidisciplinary team led by respiratory therapists.The two groups were compared in terms of ventilator-associated pneumonia(VAP)incidence,delirium episodes,mortality rate,ICU length of stay,oxygenation index on day 1 and 8 post-rehabilitation,extubation success rate,pressure injury incidence,deep vein thrombosis incidence,ICU costs,adverse events during rehabilitation,and compliance with the program.Results:In the observation group,the average duration of mechanical ventilation was(6.22±2.30)days,and the average length of ICU stay was(9.20±1.55)days,and the median ICU hospitalization costs(49835.46(32178.02,75958.55)yuan)were all lower than those of the control group((15.60±5.00)days,(17.23±5.23)days,91061.00(75433.83,122598.44)yuan)while their incidence of VAP(0.0%,0/54),delirium(5.6%,3/54),pressure injury(0.0%,0/54),deep vein thrombosis(1.9%,1/54),success rate of weaning(98.1%,53/54),mortality rate(3.7%,2/54),and the oxygenation index on the 8th day after pulmonary rehabilitation((331.31±134.35)mmHg)were all better than that of the control group(11.3%(6/53),20.8%(11/53),9.4%(5/53),13.2%(7/53),77.4%(41/53),20.8%(11/53),(276.31±80.25)mmHg,respectively),and the differences were statistically significant(t=―12.431,P<0.001;t=―10.721,P<0.001;Z=―5.499,P<0.001;χ^(2)=6.476,P=0.013;χ^(2)=4.179,P=0.041;χ^(2)=5.344,P=0.027;χ^(2)=4.364,P=0.037;χ^(2)=10.831,P=0.001;χ^(2)=5.776,P=0

关 键 词：结核 肺 通气机 机械 康复护理 方案评价 治疗结果 

分 类 号：R521[医药卫生—内科学] R47[医药卫生—临床医学]