电阻抗成像技术在医院获得性肺炎患者呼吸康复中的应用研究

Impact of electrical impedance tomography in the application of pulmonary rehabilitation in patients with hospital-acquired pneumonia

目的探讨电阻抗成像技术(electrical impedance tomography,EIT)作为医院获得性肺炎(hospitalacquired pneumonia,HAP)患者呼吸康复中胸部物理治疗(chest physiotherapy,CPT)的评估和指导手段对其症状改善时间、住院费用、住院时间和患者呼吸康复满意度的影响。方法纳入需行呼吸康复的HAP患者96例,采用随机数字表法分为对照组和试验组。两组患者在HAP的临床治疗外均进行呼吸康复CPT,每日2次,每次20 min。试验组增加EIT作为评估和指导手段,治疗前动态复查,根据结果实时调整治疗。主要结局指标是比较两组开始治疗后临床肺部感染评分(clinical pulmonary infection score,CPIS)变化,次要结局指标是比较两组HAP住院时间、HAP相关住院费用、患者呼吸康复满意度。结果治疗过程中8例患者因病情加重终止气道廓清,1例中途转院。最终纳入研究对照组43例,试验组44例。试验组CPIS在气道廓清开始后第3、7天时与对照组比较差异有统计学意义(P<0.05)。与对照组相比,试验组HAP住院时间、HAP相关住院费用、患者呼吸康复满意度均有显著性差异(P<0.01)。结论应用EIT可实时直观监测HAP患者肺通气分布情况,从而指导个体化呼吸康复治疗,能够缩短症状改善时间,减少HAP住院时间和费用,并显著提高患者呼吸康复满意度和依从性。

Objective To investigate the impact of electrical impedance tomography(EIT)as a means of assessing and guiding pulmonary rehabilitation chest physiotherapy(CPT)in hospital-acquired pneumonia(HAP)patients on the time to symptom improvement,cost of hospitalisation,length of stay and patient satisfaction with pulmonary rehabilitation.Methods Ninety-six patients with HAP requiring pulmonary rehabilitation were included in the study and were divided into control group and experimental group using the random number table method.Patients in both groups underwent pulmonary rehabilitation CPT in addition to clinical treatment for HAP,twice daily for 20 minutes each time.EIT was added to experimental group as a means of assessment and guidance,with dynamic review prior to treatment and real-time adjustment of treatment based on the results.The primary outcome indicator was a comparison of the change in clinical pulmonary infection score(CPIS)after the start of treatment in both groups,and secondary outcome indicators were a comparison of the length of HAP hospitalisation,HAP-related cost,and patient satisfaction with pulmonary rehabilitation in both groups.Results During the study,8 patients terminated airway clearance due to the aggravation of the disease,and 1 patient referral.Finally,43 patients in the study control group and 44 patients in the experimental group were included.There was a significant difference in CPIS between the test group and the control group on 3rd and 7th day after starting airway clearance(P<0.05).Compared with the control group,there were significant differences in the length of HAP hospitalisation,HAP-related cost,and patient satisfaction with airway clearance in the test group(P<0.01).Conclusion The use of EIT allows real-time visual monitoring of the distribution of lung ventilation in HAP patients,thus guiding individualized pulmonary rehabilitation treatment,which can shorten the time to symptom improvement,reduce the length and cost of HAP hospitalisation and significantly improve patient satisfaction and compliance with pulmonary rehabilitation.