中西医结合集束化肺康复策略在呼吸机依赖患者中的应用

Application of the Lung Rehabilitation Bundle Strategy Combining Traditional Chinese and Western Medicine in Ventilator Dependent Patients

目的研究中西医结合集束化肺康复策略在呼吸机依赖患者中的临床应用价值。方法选取呼吸机依赖患者108例,将其随机分为对照组与观察组各54例,对照组采用西医常规和肺康复治疗方案,观察组采用中西医结合集束化肺康复策略治疗方案,比较两组患者的中医证候积分、临床疗效、临床肺部感染评分(CPIS)、氧合指数(P/F)、最大吸气负压(MIP)、咳嗽峰流速(PEF)、膈肌位移(DE)、膈肌增厚分数(DTF)、呼吸机相关肺炎(VAP)发生率、机械通气时间、24 h再插管率、撤机成功率和ICU住院时间的差异。结果观察组的中医证候积分、临床疗效、PEF、MIP、DE、DTF均优于对照组,VAP发生率、机械通气时间、24 h再插管率及ICU住院时间明显低于对照组,而撤机成功率则显著高于对照组(P<0.05)。结论采用中西医结合集束化肺康复策略治疗肺肾气虚型呼吸机依赖患者,可以有效改善患者的临床症状,提高P/F,增强呼吸肌力量,提高膈肌运动度,改善呼吸功能,减少24 h再插管率,提高撤机成功率,还能降低CPIS评分,降低VAP发生率,缩短机械通气时间和ICU住院时间,改善患者的预后,提高生存质量。

Objective:To study the clinical application value of the combination of traditional Chinese medicine and western medicine in lung rehabilitation bundle strategy for ventilator dependent patients.Methods:A total of 108 cases of ventilator dependent patients were selected and randomly divided into the control group(54 cases)and the observation group(54 cases).The control group was treated with conventional western medicine and pul-monary rehabilitation,while the observation group adopted the treatment scheme of lung rehabilitation bundle strat-egy based on combination of traditional Chinese and western medicine.The dfferences between the two groups in TCM syndrome score,clinical efficacy,clinical pulmonary infection score(CPIS),oxygenation index(P/F),maxi-mum inspiratory negative pressure(MIP),peak cough flow rate(PEF),diaphragm displacement(DE),diaphragm thickening score(DTF),VAP incidence,mechanical ventilation time,24 h reintubation rate,weaning success rate and ICU hospitalization time were compared and analyzed.Results:The TCM syndrome score,clinical efficacy,PEF,MIP,DE,DTF of the observation group were better than those of the control group.The incidence of VAP,the time of mechanical ventilation,the rate of 24 hour re intubation and the length of stay in ICU in the observa-tion group were significantly lower than those in the control group,while the success rate of weaning was signifi-cantly higher than that in the control group(P<0.05).Conclusion:The treatment of ventilator dependent patients with deficiency of lung and kidney qi by the lung rehabilitation bundle strategy combining traditional Chinese and western medicine can effectively improve the clinical symptoms of patients,improve oxygenation index,enhance re-spiratory muscle strength,improve diaphragm mobility,improve respiratory function,reduce the rate of re intuba-tion in 24 hours,improve the success rate of weaning,reduce the CPIS score,reduce the incidence of VAP,shorten the duration of mechanical ventilation and ICU hospitalization,and improve the prognosis of patients,and improve the quality of life.