重症医学科内部跨领域团队对慢重症患者整体救治的新模式探讨——附1例AECOPD患者的临床资料分析

Discussion on a new model of holistic treatment for chronic critical illness patients by internal cross-disciplinary team in the department of intensive care unit:clinical data analysis of a case of acute exacerbation of chronic obstructive pulmonary disease

目的探讨组建重症医学科内部跨领域合作团队(ICDT)对慢重症(CCI)患者整体救治新模式的应用效果。方法通过介绍福建医科大学附属第二医院重症医学科收治的1例60岁男性慢性阻塞性肺疾病急性加重期(AECOPD)患者在重症监护病房(ICU)内的整体监护治疗方案,分析医师、护师、呼吸治疗师、物理治疗师、临床营养师及患者家属组成的ICDT在患者撤离呼吸机(撤机)和超早期康复中的作用。结果该患者入院诊断为AECOPD、吸入性肺炎、Ⅱ型呼吸衰竭、感染性休克,由重症医学科组成的ICDT团队在传统控制感染和支持治疗基础上对患者积极开展危重症早期康复治疗。在ICDT团队监护治疗下,患者外周血白细胞计数(WBC)、中性粒细胞计数(NEU)、降钙素原(PCT)、动脉血二氧化碳分压(PaCO_(2))、最大吸气压(MIP)、最大呼气压(MEP)、右侧膈肌移动度、痰液黏稠度、潮气量(VT)、呼吸频率(RR)均有所改善,随后逐渐更改呼吸机模式并下调呼吸机参数,于ICU治疗10 d后成功撤机,撤机后患者简易肺功能指标好转,住院15 d后转出ICU在普通病房治疗,住院第20 d出院。CCI门诊随访患者恢复良好,生活质量大幅改善。结论ICDT合作对CCI患者的监护治疗十分重要,有利于危重症患者的超早期康复及预后改善。

Objective To explore the effect of setting up an internal-cross disciplinary team(ICDT)in the intensive care unit(ICU)on a new model of overall treatment for patients with chronic critical illness(CCI).Methods A 60-year-old male patient with acute exacerbation of chronic obstructive pulmonary disease(AECOPD)admitted to ICU in the Second Affiliated Hospital of Fujian Medical University was introduced.The role of ICDT composed of physicians,nurses,respiratory therapists,physiotherapists,clinical dietitians and patients'family members in ventilator withdrawal and super-early rehabilitation was analyzed in this case.Results The patient was diagnosed as AECOPD,typeⅡaspiration penumonia respiratory failure,septic shock.The ICDT in ICU carried out early rehabilitation treatment for the patient on the basis of traditional infection control and supportive treatment.Under the care of the ICDT,peripheral blood white blood cell count(WBC),neutrophil count(NEU),procalcitonin(PCT),arterial partial pressure of carbon dioxide(PaCO_(2)),maximum inspiratory pressure(MIP),maximum expiratory pressure(MEP),right excursion of diaphragm,sputum viscosity,tidal volume(VT)and respiratory rate(RR)were improved.Subsequently,the ventilator mode was gradually changed and the ventilator parameters were down-regulated.The ventilator was successfully weaned on the 10th day of treatment.After weaning,the patient's bedside pulmonary function indicators improved,and he was transferred out of ICU on the 15th day of treatment and discharged on the 20th day.The mental state of the patients was good and the quality of life was greatly improved in CCI outpatient follow-up.Conclusions ICDT cooperation is very important for monitoring and treatment of CCI patients,which is beneficial to the super-early rehabilitation and prognosis improvement of critically ill patients.