直立床训练在康复科气管切开患者中的应用

Application of vertical bed training on patients with tracheotomy in rehabilitation

目的：探讨直立床训练对转入康复科的气管切开患者气管留置套管时间及肺部感染控制的影响。方法将65例气管切开超过1个月并合并肺部感染的患者按分层区组随机化分组法将患者分为对照组33例和观察组32例，对照组实施常规气切护理及康复干预措施，观察组在此基础上增加电动式直立床训练。比较两组患者在留置套管拔管率、肺部感染情况、痰细菌学培养及临床肺部感染评分（ CPIS）情况。结果两组各有1例患者失访。干预后，观察组和对照组患者的CPIS均低于干预前，差异有统计学意义（t 值分别为9．276，6．609；P＜0．01）。干预后观察组气管切开留置套管拔管率为71.0％，肺部感染痊愈率为64．5％，痰培养阴性率为48．4％，CPIS 为（2．8±1．1）分，均优于对照组[43.8％，37．5％，25．0％，（3．9±1．5）分]，差异有统计学意义（χ2/t值分别为4．76，4．60，6．22，3．36；P＜0.05）。结论直立床训练可以有效缩短康复科气管切开患者的气管切开置管时间，有利于控制肺部感染。

Objective To investigate the effect of vertical bed training on the extubation time and pulmonary infection of patients with tracheotomy in rehabilitation department .Methods Sixty-five new patients with tracheotomy and pulmonary infection more than a month were randomly divided into the control group （33 cases） and the observation group （32 cases） by stratified block randomization .All the patients received routine nursing and rehabilitation therapy , in addition, the patients in the observation group received electrodynamic vertical bed training .The decannulation rate , cure rate of pulmonary infection , sputum culture negative rate and the clinical pulmonary infection scale （ CPIS） were compared.Results One patient was lost in each of the groups during follow up .After the nursing intervention , the CPIS of the observation group was significantly lower than that in the control group （t=9.276,6.609, respectively;P〈0.01）.22 patients （71.0%） in the control group removed the tracheal tube;20 patients （64.5%） cured of pulmonary infection;15 patients （48.4%） had negative sputum culture;the sare of CPIS was （2.8 ±1.1）, those values of the control group were 43.8%, 37.5%, 25.0%and （3.9 ±1.5）.There were significant differences between groups （ t/χ2 =4.76,4.60, 6.22,3.36, respectively;P〈0.05）.Conclusions Vertical bed training can reduce the time of tracheostomy , and help in control the pulmonary infection of patients with tracheotomy in rehabilitation department .