多学科协作模式下早期分级呼吸重症康复训练应用于机械通气患者效果研究

Effect of early graded respiratory severe rehabilitation training for patients with mechanical ventilation under multidisciplinary cooperation mode

目的探讨多学科模式下早期分级呼吸重症康复训练对机械通气患者的应用效果。方法纳入2019年6月3日至2020年3月31日入住安徽医科大学第一附属医院重症医学科患者共236例,随机分为观察组和对照组,各118例。观察组采用多学科协作模式下早期分级呼吸重症康复训练,对照组采用常规呼吸康复训练。使用超声测量两组患者撤机前膈肌位移(DE)、膈肌增厚分数(DTF),记录并比较两组DE、DTF、氧合指数、咳嗽峰流速(PEF)、最大吸气负压(MIP)、撤机成功率、机械通气时间、重症加强治疗病房(ICU)住院时间的差异。结果观察组各评价指标变化较对照组差异有统计学意义(均P<0.05),其中氧合指数、PEF、MIP、急性生理学和慢性健康状况评分、临床肺部感染评分康复措施与康复时间之间存在交互作用。结论多学科模式下早期分级呼吸重症康复训练可以改善机械通气患者的呼吸功能,缩短机械通气时间和ICU住院时间。

Objective To explore the effect of early graded respiratory severe rehabilitation training for patients with mechanical ventilation under a multidisciplinary model.Methods Two hundred and thirty-six patients were surveyed,who were hospitalized in the intensive care unit of the First Affiliated Hospital of Anhui Medical University from June 3,2019 to March 31,2020.They were randomly divided into an observation group and a control group,with118 patients in each group.The observation group received rehabilitation training using early graded rehabilitation training under the mode of multidisciplinary cooperation,while the control group received routine respiratory rehabilitation training.Diaphragmatic excursion(DE)and diaphragmatic thickening fraction(DTF)of the patients before ventilator weaning were measured by ultrasound.The differences of DE,DTF,peak expiratory flow(PEF),maximal inspiratory pressure(MIP),success rate of withdrawal,duration of mechanical ventilation and intensive care unit(ICU)stay between the two groups were recorded and compared.Results All evaluation indexes were statistically significant between the observation group and the control group(all P<0.05).There were interaction between oxygenation index,PEF,MIP,Acute Physiology and Chronic Health Score,Clinical Pulmonary Infection Score and recovery time.Conclusion Rehabilitation training on early graded severe respiratory diseases under a multidisciplinary model can improve the respiratory function of patients on mechanical ventilation and shorten the duration of mechanical ventilation and ICU stay.