呼吸康复训练联合针灸治疗在呼吸衰竭患者脱机治疗中的临床意义探讨

The clinical significance of respiratory rehabilitation training combined with acupuncture therapy in the ventilator weaning of patients with respiratory failure

目的探讨呼吸康复训练联合针灸治疗在呼吸衰竭(呼衰)患者脱机治疗中的临床意义。方法采用回顾性调查研究方法,选择2010年1月至2020年11月在甘肃中医药大学第三附属医院重症医学科住院的96例呼衰患者作为观察对象,其中49例应用呼吸康复训练联合针灸治疗患者作为观察组〔平均年龄(56.71±8.61)岁〕,另47例未应用呼吸康复训练联合针灸治疗的患者为对照组〔平均年龄(57.52±7.91)岁〕。观察两组患者慢性支气管炎、肺结核、肺气肿、心衰等疾病并发症的发生率,收集患者血红蛋白(Hb)、C-反应蛋白(CRP)、降钙素原(PCT)、血氧饱和度(SO_(2))等监测指标,比较两组患者脱机成功率、1个月呼衰复发率、6个月病死率。结果与对照组比较,观察组呼衰患者脱机成功率明显提高〔53.06%(26/49)比38.30%(18/47)〕;1个月呼衰复发率、6个月病死率、呼吸机相关性肺炎(VAP)发生率、呼吸机相关性肺损伤(VALI)发生率均明显降低〔1个月呼衰复发率:20.41%(10/49)比40.43%(19/47),6个月病死率:18.37%(9/49)比38.30%(18/47),VAP发生率:24.49%(12/49)比48.94%(23/47),VALI发生率:20.41%(10/49)比31.91(15/47),均P<0.05〕。观察组患者Hb、CRP、PCT水平较对照组明显降低〔Hb(g/L):12.25±4.65比16.54±3.42,CRP(μmol/L):28.48±2.36比68.54±1.32,PCT(g/L):11.48±1.36比28.54±1.32,均P<0.05〕,SO_(2)明显升高(%:98.54±11.32比88.48±12.36,P<0.05)。观察组并发症发生率亦明显低于对照组〔慢性支气管炎:24.49%(12/49)比42.55(20/47),肺结核:12.24%(6/49)比21.28%(10/47),肺气肿:16.33%(8/49)比25.53%(12/47),心衰:16.33%(8/49)比27.66%(13/47),均P<0.05〕。结论与常规治疗相比,呼吸康复训练联合针灸治疗在呼衰患者脱机治疗中作用显著,保证了重要生命器官的血氧供应,防止了心衰、呼衰互为因果的恶性循环造成的病情不断恶化,提高患者的生活质量,临床疗效肯定,值得推广。

Objective To explore the clinical significance of respiratory rehabilitation training combined with acupuncture therapy in ventilator weaning in patients with respiratory failure.Methods Using retrospective investigation,96 patients with respiratory failure who were admitted to the department of critical care medicine of the Third Affiliated Hospital of Gansu University of Traditional Chinese Medicine were selected as the objects of observation,of which 49 patients were treated with respiratory rehabilitation training combined with acupuncture as the treatment group[average age was(56.71±8.61)years old],and 47 other patients who did not apply respiratory rehabilitation training combined with acupuncture treatment were in the control group[average age was(57.52±7.91)years old].Observing the incidence of chronic bronchitis,tuberculosis,emphysema,heart failure and other diseases in two groups,hemoglobin(Hb),C-reactive protein(CRP),procalcitonin(PCT)to monitor the oxygen saturation(SO_(2))of patients were collected,comparing the weaning success rate,1-month recurrence rate of respiratory failure and 6-month fatality rate.Results Compared with the control group,the weaning success rate was significantly improved in patients with call-down in the observation group[53.06%(26/49)vs.38.30%(18/47)].The incidence of 1-month call-down,6-month fatality,ventilator associated pneumonia(VAP)and ventilator-associated lung injury(VALI)were all significantly reduced[1-month call-down incidence:20.41%(10/49)vs.40.43%(19/47),6-month fatality rate:18.37%(9/49)vs.38.30(18/47),the rate of VAP:24.49%(12/49)vs.48.94(23/47),the rate of VALI:20.41%(10/49)vs.31.91(15/47),all P<0.05].The Hb,CRP and PCT levels in the observation group were significantly lower than those in the control group[Hb(g/L):12.25±4.65 vs.16.54±3.42,CRP(μmol/L):28.48±2.36 vs.68.54±1.32,PCT(g/L):11.48±1.36 vs.28.54±1.32,all P<0.05].SO_(2) was significantly increased(%:98.54±11.32 vs.88.48±12.36).The incidence of complications in the observation group was also significantly lower than those in the control group[chronic bronchitis:24.49%(12/49)vs.42.55%(20/47),tuberculosis:12.24%(6/49)vs.21.28%(10/47),emphysema:16.33%(8/49)vs.25.53%(12/49),heart failure:16.33%(8/49 vs.27.66%(13/47),all P<0.05].Conclusions Compared with conventional treatment,respiratory rehabilitation training combined with acupuncture treatment plays a significant role in the weaning treatment of patients with hypothermia,ensuring the supply of blood oxygen to important life organs,preventing the call-down and causal vicious cycle caused by the deterioration of the disease of heart failure,improving the quality of life of patients,heart failure heart failure worthy of promotion.