呼吸康复在儿科重症监护室中的早期应用研究

Early respiratory rehabilitation for critically ill children with mechanical ventilation

目的探索在PICU内早期应用呼吸干预技术促进患儿康复的效果。方法组建呼吸康复团队,参考成人重症患者呼吸康复经验,制定重症患儿的早期呼吸康复介入方法,对机械通气患儿生命体征稳定24 h后开始实施床旁早期康复,观察其康复效果和不良事件。结果根据患儿病情,共23例PICU机械通气患儿实施个体化的呼吸康复干预方案,其中男10例,女13例,年龄57.0(17.5,91.5)个月;总计呼吸康复729人次,无一例发生不良事件,康复会诊的时间是机械通气后8.0(4.0,18.0)d,插管时间为693.5(345.2,1027.1)h。其中有16例在出院前完成脱机,其插管时间为566.2(243.4,928.7)h,自呼吸康复介入后到拔管的时间为168.0(6.0,564.0)h,与前期19例只进行肢体运动康复的患儿[插管时间381.7(309.6,541.4)h,康复实施距离拔管时长187.2(81.5,382.9)h]相比,呼吸康复的患儿插管时间略长,而康复实施距离拔管时间较短,但差异均无统计学意义(P均>0.05)。结论对PICU危重症患儿进行早期呼吸康复是安全、可行的。

Objective To develop the early respiratory rehabilitation techniques in pediatric intensive care unit(PICU)for children with mechanical ventilation.Methods A respiratory rehabilitation team was established,and early respiratory rehabilitation intervention methods for critically ill children were also developed.Early bedside rehabilitation were implemented after the vital signs of mechanical ventilation children were stable for 24 hours,and the rehabilitation effect and adverse events were observed.Results According to the patient′s condition,23 patients in PICU received early respiratory rehabilitation after incubations,including 10 males and 13 females,aged 57.0(17.5,91.5)months.There was no adverse event in 729 rehabilitation practices.The average consulting time was 8.0(4.0,18.0)days after incubations.The average incubation time was 693.5(345.2,1027.1)hours of all the patients.As to 16 patients who were weaned before charged out,the average incubation time was 566.2(243.4,928.7)hours,and the average incubation time from respiratory rehabilitation performance to weaning was 168.0(6.0,564.0)hours.In 19 patients who only received limbs massage and passive movements,the average incubation time was 381.7(309.6,541.4)hours and the average incubation time from respiratory rehabilitation performance to weaning was 187.2(81.5,382.9)hours.However the difference between these who received respiratory rehabilitation and only received limbs massage and passive movements was not statistically significant.Conclusion It′s safe and feasible to perform the early respiratory rehabilitation in PICU for critically ill children with mechanical ventilation.