渐进式早期康复训练在气管插管术后患者中的应用

Application of progressive early rehabilitation training in patients after tracheal intubation surgery

目的观察对气管插管术后患者实施渐进式早期康复训练,对其预后康复效果的影响。方法将2021年10月至2022年12月期间在南京中医药大学连云港附属医院收治的80例气管插管患者作为研究对象,根据随机数字表法分为观察组和对照组,各40例。对照组患者男女比例为20∶20,年龄(67.45±4.45)岁;观察组患者男女比例为22∶18,年龄(67.05±4.33)岁。对照组采用常规护理(包含体征检测、呼吸道护理、环境管控及康复训练),观察组采用渐进式早期康复训练(包含方案制定、第一阶段、第二阶段及第三阶段)。于入院当日、出院前1 d对比两组患者血气指标及临床治疗指标,使用肺部治疗功能评定量表(Functional Assessment of Cancer Therapy for Lung Cancer,FACT-L)测评两组患者治疗效果。采用t检验、χ^(2)检验。结果出院前1 d,观察组患者血气指标中的动脉血二氧化碳分压(PaCO_(2))(36.54±4.55)mmHg(1 mmHg=0.133 kPa)、碱剩余(BE)(2.79±0.79)mmol/L及动脉血氧分压(PaO_(2))(101.66±7.77)mmHg均高于对照组的(34.28±4.17)mmHg、(2.33±0.71)mmol/L及(97.88±6.99)mmHg,两组对比差异均有统计学意义(P=0.023、0.008、0.025)。观察组患者的气管拔管时间(3.21±0.42)d、ICU住院时间(7.65±0.75)d及总住院时间(13.55±2.65)d均短于对照组(3.55±0.55)d、(8.22±0.88)d、(14.99±2.99)d,两组对比差异均有统计学意义(P=0.003、0.003、0.026)。观察组患者FACT-L中的生理健康[(26.89±3.67)分]、心理状态[(27.13±3.46)分]、独立能力[(25.67±3.55)分]及社会关系评分[(26.77±3.49)分]均高于对照组[(25.22±3.49)分、(24.47±3.46)分、(23.35±3.31)分、(24.99±3.24)分],两组对比差异均有统计学意义(P=0.040、0.001、0.003、0.021)。结论实施渐进式早期康复训练可改善气管插管患者术后插管时间,逐渐提升其肺功能,值得临床推广。

Objective To observe the impact of progressive early rehabilitation training on the prognosis and rehabilitation outcomes in patients after tracheal intubation surgery.Methods Eighty patients with tracheal intubation who were admitted to Lianyungang Affiliated Hospital of Nanjing University of Traditional Chinese Medicine from October 2021 to December 2022 were selected as the study subjects.According to the random number table method,they were divided into an observation group and a control group,with 40 patients in each group.In the control group,the ratio of male to female was 20∶20,and the age was(67.45±4.45)years old.In the observation group,the ratio of male to female was 22∶18,and the age was(67.05±4.33)years old.The control group used conventional nursing(including physical sign detection,respiratory tract care,environmental control,and rehabilitation training),while the observation group received progressive early rehabilitation training(including program development,the first stage,the second stage,and the third stage).On the day of admission and one day before discharge,the blood gas and clinical treatment indicators of the two groups were compared,and the treatment effects of the two groups were evaluated by the Functional Assessment of Cancer Therapy for Lung Cancer(FACT-L).t test andχ^(2) test were used.Results One day before discharge,the arterial partial pressure of carbon dioxide(PaCO_(2))[(36.54±4.55)mmHg(1 mmHg=0.133 kPa)],buffuer excess(BE)[(2.79±0.79)mmol/L],and arterial partial pressure of oxygen(PaO_(2))[(101.66±7.77)mmHg]of the observation group were higher than those of the control group[(34.28±4.17)mmHg,(2.33±0.71)mmol/L,and(97.88±6.99)mmHg],with statistically significant differences between the two groups(P=0.023,0.008,and 0.025).The tracheal extubation time[(3.21±0.42)d],length of ICU stay[(7.65±0.75)d],and total length of hospital stay[(13.55±2.65)d]in the observation group were shorter than those in the control group[(3.55±0.55)d,(8.22±0.88)d,and(14.99±2.99)d],with statistically significant differences between the two groups(P=0.003,0.003,and 0.026).The scores of physiological health[(26.89±3.67)points],psychological state[(27.13±3.46)points],independent ability[(25.67±3.55)points],and social relation of the FACT-L[(26.77±3.49)points]of the observation group were higher than those of the control group[(25.22±3.49)points,(24.47±3.46)points,(23.35±3.31)points,and(24.99±3.24)points],with statistically significant differences between the two groups(P=0.040,0.001,0.003,and 0.021).Conclusion Implementing progressive early rehabilitation training can improve the postoperative intubation time in patients with tracheal intubation,and gradually improve their lung function,worthy of clinical promotion.