早期肺康复训练在AECOPD患者机械通气治疗中的临床意义

Clinical sigrificance of early lung rehabilitation training in mechanical ventilation treatment of AECOPD patients

目的分析早期肺康复训练在慢性阻塞性肺病急性加重期(acute exacerbations of chronic obstructive pulmonary disease,AECOPD)患者机械通气治疗中的临床意义。方法选择2020年5月至2021年10月在我院呼吸与危重症医学科住院治疗的72例AECOPD患者为对象,随机分为观察组37例和对照组35例,对照组采取常规抗感染、祛痰、解痉、呼吸机支持等治疗,观察组在此基础上从机械通气开始给与肢体训练、吸气肌抗阻、主动呼吸循环训练;检测两组患者PaO_(2)、PaCO_(2)、pH、乳酸,观察两组患者下肢静脉血栓发生率、机械通气时间、ICU平均住院时间及呼吸机相关肺炎发生率。结果观察组下肢静脉血栓发生率(5.76%vs.20.00%)、机械通气时间(11.40±1.32 vs.14.46±1.86)d、ICU平均住院时间(16.15±1.93 vs.18.55±2.34)d及呼吸机相关肺炎发生率(9.61%vs.26.00%)优于对照组(P<0.05),观察组PaCO_(2)第5天(44.07±11.00 vs.52.89±5.52)mmHg和第10天(41.87±3.96 vs.45.22±3.30)mmHg低于对照组,而pH、SaO_(2)与PaO_(2)高于对照组(P<0.05)。结论对AECOPD机械通气的患者早期实施肺康复训练可显著改善血气指标,降低并发症的发生,促进早日康复具有意义。

Objective To explore the effect of early lung rehabilitation training on mechanical ventilation in patients with AECOPD.Methods 72 patients with acute exacerbations of chronic obstructive pulmonary disease(AECOPD)hospitalized in the department of respiratory and critical care medicine of our hospital from May 2020 to October 2021 were randomly divided into observation group 37 cases and control group 35 cases.The control group was treated with anti infection,expectorant,antispasmodic and ventilator support.On this basis,the observation group was given limb training,inspiratory muscle resistance and active respiratory and circulatory training from mechanical ventilation.PaO_(2),PaCO_(2),pH and lactic acid were measured.The incidence of lower extremity venous thrombosis,mechanical ventilation time,average length of stay in ICU and the incidence of ventilator-associated pneumonia were observed.Results The incidence of lower extremity venous thrombosis(5.76%vs.20.00%),mechanical ventilation time(11.40±1.32 vs.14.46±1.86)d,average length of stay in ICU(16.15±1.93 vs.18.55±2.34)d and the incidence of ventilator-associated pneumonia(9.61%vs.26.00%)in the observation group were better than those in the control group(P<0.05).On the 5 th day(44.07±11.00 vs.52.89±5.52)mmHg and 10 th day(41.87±3.96 vs.45.22±3.30)mmHg,the node PaCO_(2) of the observation group was lower than that of the control group,while the pH value,SaO_(2) and PaO_(2) were higher than those of the control group(P<0.05).Conclusion Early pulmonary rehabilitation training for patients with AECOPD mechanical ventilation can significantly improve the blood gas indexes of patients with COPD.Reduce the occurrence of complications and promote the early recovery of patients.