早期综合肺康复用于脱机后慢性阻塞性肺疾病急性加重合并肺性脑病效果观察

Efficacy of early comprehensive lung rehabilitation after ventilator weaning in acute exacerbation COPD patients complicated with pulmonary encephalopathy

目的探讨早期综合肺康复对脱机后慢性阻塞性肺疾病急性加重(AECOPD)合并肺性脑病患者的疗效及心理状态的影响。方法选取2017年5月至2018年12月因AECOPD合并Ⅱ型呼吸衰竭、肺性脑病在绍兴市人民医院呼吸重症监护室经气管插管等治疗脱机后转入呼吸内科的患者63例,采用随机数字表法分为康复组32例和常规组31例,常规组予常规的抗菌药物、支气管扩张剂、糖皮质激素等治疗,康复组是在常规治疗基础上配合肺康复锻炼,随访3个月后比较两组患者肺功能指标[用力肺活量(FVC)、第1秒用力呼气量(FEV1)占预计值比值(FEV1%pred)、FEV1/FVC比值]、6 min步行距离(6 MWD)、慢性阻塞性肺疾病自我评估测试(CAT)评分、呼吸困难指数(m MRC)评分、BODE指数的变化,并采用抑郁自评量表(SDS)评估两组患者精神状态的变化。结果最终两组患者均有29例获得全部随访。经过3个月的康复锻炼,康复组患者FVC、FEV1%pred、FEV1/FVC比值、6 MWD均明显高于常规组,而CAT评分、m MRC评分、BODE指数及SDS评分均明显低于常规组,差异均有统计学意义(均P<0.05)。结论对于AECOPD合并肺性脑病经机械通气等治疗脱机后的患者尽早进行综合肺康复是可行的,能够缓解临床症状,提高患者运动能力,改善心理状态。

Objective To assess the efficacy of early comprehensive lung rehabilitation after ventilator weaning in acute exacerbation COPD(AECOPD)patients complicated with type II respiratory failure and pulmonary encephalopathy.Methods Sixty three AECOPD patients complicated with type II respiratory failure and pulmonary encephalopathy were admitted to respiratory ICU from May 2017 to December 2018,then transferred to the Department of Respiratory Medicine after weaning of mechanical ventilation.Among them,31 patients received antibiotics,bronchodilators,glucocorticoids and other conventional treatment(control group),and 32 patients received pulmonary rehabilitation exercise in addition of conventional treatment(rehabilitation group).After 3 months of treatment,the pulmonary function indicators,6-min walking distance(6 MWD),CAT score,dyspnea index(mMRC),BODE index were compared between two groups,and the mental state measured by the depre-ssion self-rating scale(SDS)was also compared.Results After 3 months of treatment,pulmonary function indicators and 6MWD of patients in the rehabilitation group were significantly higher than those in the control group,while CAT score,mMRC score,BODE index and SDS score were significantly lower than those in the control group(all P<0.05).Conclusion For patients with AECOPD complicated with pulmonary encephalopathy,it is feasible to carry out comprehensive pulmonary rehabilitation soon after weaning with mechanical ventilation,which can alleviate clinical symptoms,improve exercise ability and mental state of patients.