早期肺康复在AECOPD伴呼吸衰竭患者中的应用效果

Effects of early pulmonary rehabilitation for AECOPD tients with respiratory failure

目的探讨AECOPD伴呼吸衰竭患者行机械通气治疗期间进行早期肺康复的效果评价。方法将2013年12月至2015年7月入住ICU的AECOPD伴呼吸衰竭行机械通气的患者42例随机分为康复组22例和对照组20例。康复组在对照组治疗的基础上行机械通气下的肺康复锻炼，比较两组在行机械通气治疗的第1天、第7天、第14天相同时间段最大吸气压（M1P）、简化的临床肺部感染评估表（CPIS评分）、左右手握力，同时观察记录两组患者的机械通气时间、住ICU时间及住院总费用。结果两组在行机械通气的第1天相同时间段最大吸气压（MIP）、简化的临床肺部感染评估表（CHS评分）、左右手握力比较，差异均无统计学意义（P〉0．05），而进行早期肺康复后第7天、第14天康复组最大吸气压、左右手握力均有明显改善（P〈0．05），而CHS评分差异无统计学意义（P〉0．05）。与对照组相比，康复组行机械通气的时间、入住ICU的时间及住院费用方面差异均有统计学意义（P〈0．05）。结论本研究表明AECOPD伴呼吸衰竭患者行机械通气治疗期间进行早期肺康复锻炼是安全可行的，能够维持和增加患者机械通气期间的握力，缩短患者机械通气时间，减少住院费用。

Objective To explore the effects of early pulmonary rehabilitation for AECOPD patients with respiratory failure using mechanical ventilation. Methods A total of 42 AECOPD patients with respiratory failure undergoing mechanical ventilation in ICU from December 2013 to July 2015 were randomly divided into rehabilitation group and control group. The patients of the Control group received routine care and nursing. While the patients of the rehabilitation group received pulmonary rehabilitation under the mechanical ventilation on the basis of the control group. The MIP, CPIS score, left and right hand grip strength of the two groups at the same time periods at the 1 st, 7th and 14th day un- der the mechanical ventilation treatment were compared. The mechanical ventilation time, time in ICU and hospitalization costs of the two groups were observed and recored. Results There was no obvious difference in therms of the MIP, CPIS score, grip strength of left and right hand at the same time period at the 1 st day under mechanical ventilation between the two groups （P〉0. 05） . The MIP, grip strength of left and right hand of rehabilitation group at the 7th and 14th day after early pulmonary rehabilitation were better improved （P〈0. 05） , while there was no obvious difference in terms of CPIS score （ P〉0. 05 ） . There were significant differences in terms of the mechanical ventilation time, time in ICU and hospitalization costs between the two groups （P〈0. 05） . Conclusions These findings suggest that early pulmonary rehabilitation for AECOPD patients with respiratory failure undergoing mechanical ventilation is safe and feasible. The pulmonary rehabilitation can maintain and increase the patients＇ grip strength, shorten the time of mechanical ventilation and reduce hospitalization costs.