早期综合肺康复干预对有创机械通气患者呼吸机相关性肺炎的预防效果观察

A preventive effect of early and comprehensive pulmonary rehabilitation on pneumonia associated with invasive mechanical ventilation

目的观察早期综合肺康复干预对有创机械通气(MV)患者呼吸机相关性肺炎(VAP)的预防效果。方法选取117例首次入住重症监护病房(ICU)、机械通气≥48 h的成年患者,采用随机数字表法将其分为观察组及对照组。对照组患者给予常规药物治疗及护理,观察组患者在此基础上辅以气道廓清技术治疗、呼吸训练、膈神经电刺激、膨肺、早期活动等个体化早期综合肺康复干预。分别评估2组患者入院及出院时情况,主要观察指标包括VAP发生率、死亡率、MV时长、ICU停留时间、住院总时长等。结果治疗结束时观察组患者临床肺部感染积分(CPIS)、急性生理及慢性健康状况评分Ⅱ(APACHEⅡ)、血氧饱和度(SpO2)及氧合指数分别为(2.66±1.15)分、(14.36±7.75)分、(99.14±1.34)%、(355.91±110.32)mmHg,对照组分别为(4.55±1.96)分、(18.60±9.98)分、(98.22±2.41)%、(288.36±129.05)mmHg,观察组上述指标均优于对照组水平,组间差异均具有统计学意义(P<0.05);观察组VAP发生率为47.46%,出ICU后1个月死亡率为44.07%,对照组分别为70.69%和75.86%,组间差异均具有统计学意义(P<0.05);观察组MV时长为(9.19±5.49)d,总住院时长和ICU停留时间分别为(20.73±10.88)d、(14.93±8.31)d,对照组分别为(12.10±6.35)d、(27.29±19.5)d、(18.79±9.66)d,观察组上述指标时长均明显短于对照组,组间差异均具有统计学意义(P<0.05)。结论早期综合肺康复干预能预防MV患者VAP发生,同时还能缩短住院时长、ICU停留时间及MV时长,提高患者存活率及整体预后。

Objective To observe any effect of pulmonary rehabilitation in preventing ventilator-associated pneumonia (VAP) among patients receiving invasive mechanical ventilation (MV). Methods A total of 117 adults who had be receiving mechanical ventilation for at least 48 hours were randomly divided into an observation group and a control group. Both groups were given routine drug treatment and nursing, but the observation group also received comprehensive and individualized pulmonary rehabilitation interventions including airway clearance, respiration training, electrical stimulation of the sacral nerve, lung expansion and early mobilization. The main indicators were the incidence of VAP, mortality, MV duration, ICU stay time, and total hospital stay. Results At the end of the treatment the average clinical pulmonary infection score, the acute physiology and chronic health evaluation II score, SpO2 level and oxygenation index of the observation group were all significantly better than those of the control group. The incidence of VAP within one month after leaving the ICU was 47.5% in the observation group and the mortality rate was 44.1%, both significantly lower than in the control group. The average MV duration, total hospitalization time and the ICU stay of the observation group were also significantly shorter than those of the control group. Conclusion Early and comprehensive pulmonary rehabilitation can prevent VAP and shorten the length of hospital stays, ICU stays and time on a mechanical ventilator, improving patients′ survival chances and prognoses.