早期综合肺康复干预对综合ICU呼吸机相关性肺炎的防控效果

Prevention and control effect of early comprehensive lung rehabilitation intervention on ventilator-associated pneumonia caused by carbapenem-resistant Klebsiella pneumoniae in comprehensive ICU

目的探讨早期综合肺康复干预对综合ICU耐碳青霉烯类肺炎克雷伯菌致呼吸机相关性肺炎(VAP的防控效果。方法选取上海静安区闸北中心医院ICU科2017年4月至2018年5月行机械通气治疗的80例患者作为观察对象,按随机数表法分为观察组和对照组,每组40例,观察组予以早期综合肺康复干预,对照组予以常规康复干预。比较两组患者的VAP发生率、撤机时间和住院时间。结果观察组患者的VAP发生率为2.50%,明显低于对照组的15.0%,差异有统计学意义(P<0.05);观察组和对照组患者的撤机时间[(6.13±1.18) d vs (8.36±1.20) d]与住院时间[(12.15±1.22) d vs (16.98±1.36) d]比较,观察组明显短于对照组,差异均有统计学意义(P<0.05);观察组和对照组患者的p H值(7.36±0.17 vs 7.28±0.13)、血氧分压(PaO2)[(90.09±8.01) mmHg vs (75.13±15.48) mmHg]、血氧饱和度(SpO2)[(96.17±3.12)%vs (91.69±3.89)%]比较,观察组明显高于对照组;二氧化碳分压(PaCO2)[(38.61±12.92) mmHg vs (46.51±13.13) mmHg]比较,观察组明显低于对照组,差异均有统计学意义(P<0.05)。结论早期综合肺康复干预可以显著降低机械通气患者的VAP发生率,改善患者的血气情况,进而促进患者恢复、缩短患者病程,具有临床推广价值。

Objective To explore the effect of early comprehensive pulmonary rehabilitation intervention on ventilators-associated pneumonia caused by carbapenem-resistant Klebsiella pneumoniae in the comprehensive ICU.Methods Eighty patients treated with mechanical ventilation in Intensive Care Unit, Shanghai Jing’an District Zhabei Central Hospital from April 2017 to May 2018 were selected as the research subjects. According to the random number table, the patients were divided into the observation group and the control group, with 40 patients in each group. The observation group received early comprehensive pulmonary rehabilitation intervention, and the control group received routine rehabilitation intervention. The incidence of VAP, withdrawal time, and length of hospital stay were compared between the two groups. Results The incidence of VAP in the observation group was 2.50%, significantly lower than15.0% in the control group(P<0.05). The withdrawal time and length of hospital stay in the observation group were significantly shorter than those in the control group(P<0.05):(6.13±1.18) d vs(8.36±1.20) d,(12.15±1.22) d vs(16.98±1.36) d. The p H value, PaO2, and SpO2 of the observation group were significantly higher than those of the control group(P<0.05):(7.36±0.17) vs(7.28±0.13),(90.09±8.01) mm Hg vs(75.13±15.48) mmHg,(96.17±3.12)% vs(91.69±3.89)%.PaCO2 in the observation group was significantly lower than that in the control group(P<0.05):(38.61±12.92) mmHg vs(46.51±13.13) mmHg. Conclusion Early comprehensive pulmonary rehabilitation intervention can significantly reduce the incidence of VAP in patients with mechanical ventilation, improve the patients’ blood and gas conditions, and thus promote the patients’ recovery and shorten the course of disease, which has the value of clinical promotion.