呼吸监护病房AECOPD合并呼吸衰竭患者早期肺康复疗效观察

Effect observation of early pulmonary rehabilitation in patients with AECOPD complicating respiratory failure in respiratory care unit

目的探讨对呼吸监护病房(RCU)慢性阻塞性肺疾病急性加重期(AECOPD)合并Ⅱ型呼吸衰竭患者早期进行肺康复的临床可行性及治疗效果。方法选取2015年6月至2016年6月西南医科大学附属医院呼吸一科需有创机械通气而入RCU的AECOPD合并Ⅱ型呼吸衰竭的患者共40例,将其分为早期康复组和对照组,各20例。两组患者均给予有创-无创序贯机械通气和常规药物治疗,其中早期康复组在护理人员帮助下进行早期肺康复治疗。比较分析两组患者机械通气时间、住院时间、治疗前后肺功能、血气分析、慢性阻塞性肺疾病评估测试问卷(CAT)及改良版英国医学研究委员会呼吸困难问卷(m MRC)评分情况。结果两组患者的肺功能、血气分析、CAT评分和m MRC评分均较入院时改善,差异有统计学意义(P<0.05);且早期康复组较对照组改善显著,差异有统计学意义(P<0.05)。早期康复组机械通气时间和住院时间较对照组缩短,差异均有统计学意义(P<0.05)。结论对RCU的AECOPD合并呼吸衰竭患者进行早期肺康复治疗有利于改善其肺功能,促进呼吸衰竭的纠正,缩短机械通气时间和住院时间,从而提高患者生活质量。

Objective To evaluate the clinical feasibility and curative effect of early pulmonary rehabilitation in the pa-tients with acute exacerbation of chronic obstructive pulmonary disease(AECOPD) complicating typeⅡ respiratory failure in respiratory care unit(RCU).Methods Forty patients with AECOPD complicating type Ⅱ respiratory failure entering RCU due to conduct the invasive mechanical ventilation in the respiration department of Affiliated Hospital of Southwest Medical University from June 2015 to June 2016 were selected and divided into the early pulmonary rehabilitation group(early PR group) and control group,20 cases in each group.All cases were given sequential invasive to noninvasive ventilation treatment following short term invasive mechanical ventilation therapy and regular medication treatment,in which the early PR group conducted the early pulmonary rehabilitation therapy with the help of nursing staff.The mechanical ventilation time,hospitalization time,lung function before and after treatment,COPD Assessment Text(CAT) scores and the Improved Respiratory Distress Questionnaire for the British Medical Research Council(m MRC) scores were compared between the two groups.Results The lung function,blood gas analysis,CAT scores and m MRC scores after treatment in both groups were improved compared with those at admission,the difference was statistically significant(P<0.05),but the improvement in the early PR group was more significant than that in the control group with statistical difference(P<0.05);the mechanical ventilation time and hospitalization time in the early PR group were shortened compared with the control group,the difference was statistically significant(P<0.05).Conclusion Early pulmonary rehabilitation in the patients with AECOPD complicating respiratory failure in RCU conduces to improve their lung function,promotes the correction of respiratory failure,and shortens the mechanical ventilation time and hospitalization time,thus increases their quality of life.