双肺移植患者肺康复方案的构建及应用

Construction and application of a pulmonary rehabilitation program in patients with double lung transplantation

目的构建双肺移植患者肺康复方案并评价其应用效果。方法采用便利抽样法,选取2020年1月—2021年3月杭州市某三级甲等医院行双肺移植术的46例患者为研究对象,采用随机数字表法分为试验组和对照组,每组各23例。试验组在对照组方案的基础上接受肺康复方案的干预,由呼吸治疗专科护士主导的肺康复小组全程指导,包括术前预康复训练和适应性训练,术后早期活动、呼吸肌训练、序贯氧疗、气道廓清、主动呼吸循环技术等;对照组接受常规治疗、健康宣教和肺康复指导。比较两组术后体外膜肺氧合辅助时间、呼吸机辅助时间、ICU住院时间、氧合指数、6 min步行试验距离、肺康复过程中不良事件发生率、肺康复训练依从性。结果试验组ICU住院时间低于对照组,氧合指数、6 min步行试验距离、肺康复训练依从性均优于对照组(P<0.05);两组体外膜肺氧合辅助时间、呼吸机辅助时间和不良事件发生率比较,差异无统计学意义(P>0.05)。结论双肺移植患者肺康复方案安全、有效,可缩短ICU住院时间,提高运动能力,促进移植肺功能早期康复。

Objective To construct a pulmonary rehabilitation program for patients with double lung transplantation and to evaluate its application effect.Methods 46 patients admitted to our hospital for double lung transplantation from January 2020 to March 2021 were selected as the research subjects.Using random number table method,they were divided into a control group and an experimental group with 23 cases each.The experimental group received the intervention of the lung rehabilitation program for patients with double lung transplantation on the basis of the control program.The pulmonary rehabilitation team led by respiratory therapy specialist nurses guided the whole process,including preoperative pre-rehabilitation training and adaptive training,early postoperative activities,and respiratory muscles training,sequential oxygen therapy,airway clearance,active breathing and circulation techniques,etc.The control group received conventional treatment,health education and pulmonary rehabilitation guidance.The postoperative ECMO assisting time,mechanical ventilation time,hospital stay,oxygenation index,6-minute walk test,incidence of adverse events,and compliance with postoperative pulmonary rehabilitation were compared between the 2 groups.Results The length of hospital stay in the experimental group was lower than that in the control group.The oxygenation index,6-minute walk test distance,and compliance with postoperative pulmonary rehabilitation were better than those in the control group(P<0.05).There was no statistical difference in the ECMO assisting time,mechanical ventilation time and the incidence of adverse events in the 2 groups(P>0.05).Conclusion The pulmonary rehabilitation program for patients with double lung transplantation is safe and effective.It can shorten the length of ICU hospitalization,improve exercise capacity,and promote early recovery of transplanted lung function.