重症机械通气患者呼吸治疗康复一体化方案的构建与实践

Construction and practice of integrated program of respiratory therapy and rehabilitation for patients with mechanical ventilation in ICU

目的:构建呼吸治疗康复一体化方案,并分析其在重症机械通气患者中的实践效果。方法:将安徽省某三级甲等医院2019年1月至2020年12月入住重症医学科行机械通气治疗的患者作为研究对象。将2020年实施由医生、呼吸治疗师、康复治疗师、护士组成的团队制定的个性化呼吸治疗康复一体化方案的患者作为观察组,将2019年行机械通气常规护理的患者作为对照组,比较两组患者的机械通气时间、气管插管时间、48 h再插管率、呼吸机相关性肺炎(VAP)发生率、谵妄发生率、ICU获得性衰弱发生率、早期功能锻炼率、干预后肌力、离床率的差异。结果:共纳入了3124例机械通气患者,观察组1673例,对照组1451例。观察组患者的机械通气时间、气管插管时间明显少于对照组,48 h再插管率、VAP发生率、谵妄发生率、ICU获得性衰弱发生率明显低于对照组,差异具有统计学意义(P<0.05);早期功能锻炼率、干预后肌力、离床率明显高于对照组,差异具有统计学意义(P<0.05)。结论:呼吸治疗康复一体化方案具有科学性和可行性,应用呼吸治疗康复一体化方案可以缩短ICU机械通气患者的机械通气时间、气管插管时间,并降低48 h再插管率、VAP发生率、谵妄发生率,具有较好的效果。

Objective:To construct an integrated respiratory therapy and rehabilitation program,and evaluate its curative effect in ICU patients with mechanical ventilation.Methods:Patients who were admitted to a tertiary grade A hospital in Anhui province for mechanical ventilation from January 2019 to December 2020 selected as research objects.The patients who implemented the individualized respiratory treatment and rehabilitation integrated program formulated by the team composed of doctors,respiratory therapists,rehabilitation therapists and nurses in 2020 were taken as the observation group,and the patients who received routine care of mechanical ventilation in 2019 were taken as the control group.Mechanical ventilation time,tracheal intubation time,48h reintubation rate,Ventilator-Associated Pneumonia(VAP)incidence,delirium incidence,ICU acquired weakness incidence,early functional exercise rate,muscle strength after intervention and out of bed rate for the two groups were compared.Results:Totally 3124 mechanically ventilated patients were included,1673 cases in the observation group and 1451 cases in the control group.Mechanical ventilation time,tracheal intubation time,48h reintubation rate,VAP incidence,delirium incidence,and ICU acquired weakness incidence of the observation group were significantly lower than those of the control group,the differences were statistically significant(P<0.05).In the early functional exercise rate,muscle strength after intervention and the out of bed rate,the observation group was significantly higher than the control group,and the differences were statistically significant(P<0.05).Conclusion:This study shows that the integrated program of respiratory therapy and rehabilitation is scientific and feasible,the application of an integrated respiratory therapy rehabilitation program can shorten mechanical ventilation time and tracheal intubation time for mechanically ventilated ICU patients,reduce the 48h reintubation rate,the incidence of VAP and delirium.