吸气肌功能训练在AECOPD序贯撤机中的应用效果分析

Application of Inspiratory Muscle Function Training in Sequential With-drawal of AECOPD

目的探讨吸气肌功能训练(IMT)在慢性阻塞性肺疾病急性加重期(AECOPD)序贯撤机中的应用效果。方法方便选取2015年4月-2017年11月该院AECOPD患者74例,根据入院顺序分组,各37例。两组均接受有创-无创序贯撤机时辅以床边纤支镜吸痰、支气管肺泡灌洗治疗,对照组给予常规训练,实验组在对照组基础上给予IMT。观察两组脱机成功率、住院时间、总机械通气时间、有创通气时间、呼吸机相关性肺炎(VAP)发生率,对比干预前后呼吸功能指标变化[吸气峰流速(PIF)、最大吸气压(MIP)]。结果干预后实验组PIF(4.12±0.75)L/s、MIP(69.91±13.55)cmH2O水平高于对照组(3.07±1.52)L/s、(50.61±18.34)cmH2O(t=3.768、5.148,P<0.05);实验组总机械通气时间、有创通气时间、住院时间短于对照组,VAP发生率(2.70%)低于对照组(24.32%),脱机成功率(91.89%)高于对照组(70.27%)(P<0.05)。结论 IMT用于AECOPD序贯撤机中,可提高脱机成功率,增强吸气功能、运动能力,加快康复进程。

Objective To explore the application effect of function training of inspiratory muscle(IMT) in sequential withdrawal of acute exacerbation chronic obstructive pulmonary disease(AECOPD). Methods 74 cases of AECOPD in the hospital from April 2015 to November 2017 were convenient selected and grouped according to the order of admission, 37 cases in each group. The two groups were treated with the bedside fiberoptic bronchoscopy for sputum absorption and bronchoalveolar lavage, and the control group was given routine training, and the experimental group was given IMT on the basis of the control group. The success rate in withdrawal, length of stay, total mechanical ventilation time, invasive ventilation time and incidence of ventilator-associated pneumonia(VAP) were observed in the two groups. The changes of respiratory function indexes before and after intervention [inspiratory peak flow rate(PIF), maximum inspiratory pressure(MIP)] and 6 min walking distance(6 MWD) were compared. Results After intervention, the levels of PIF(4.12 ±0.75) L/s and MIP(69.91±13.55) cmH2 O in the experimental group were higher than those in the control group(3.07±1.52) L/s and(50.61±18.34) cmH2 O(t=3.768, 5.148, P<0.05). The total mechanical ventilation time, invasive ventilation time and hospitalization time of the experimental group were shorter than those of the control group. The incidence of VAP(2.70%) was lower than that of the control group(24.32%). The success rate of weaning(91.89%) was higher than that of the control group(70.27%)(P<0.05). Conclusion IMT applied in AECOPD sequential withdrawal can improve the success rate of off-line, enhance inspiratory function and exercise ability, and speed up the rehabilitation process.