四级锻炼结合集束化干预对AECOPD机械通气患者血气指标及呼吸力学参数的影响

Influence of four-stage exercise combined with bundled intervention on blood gas indicators and respiratory mechanics parameters in AECOPD patients with mechanical ventilation

目的探讨四级锻炼结合集束化干预对慢性阻塞性肺疾病急性加重期(AECOPD)机械通气患者血气指标及呼吸力学参数的影响效果。方法选择2021年1月至2023年9月期间收治的86例AECOPD机械通气患者,按照随机数字表法分为联合组和常规组,各43例。常规组提供常规护理及康复训练干预,联合组在常规组基础上采用四级锻炼结合集束化干预。比较两组干预前后血气指标[动脉二氧化碳分压(PaCO_(2))、动脉氧分压(PaO_(2))、氧合指数(PaO_(2)/FiO_(2))]、呼吸力学参数[气道阻力(Raw)、气道平均压(mPaw)、气道平台压(Pplat)]、呼吸困难状况[改良版呼吸困难问卷(mMRC)、慢性阻塞性肺疾病评估量表(CAT)]、机械通气相关并发症、护理舒适度[Kolcaba舒适状况量表(GCQ)]及生活质量[圣乔治呼吸问卷(SGRQ)]评分。结果干预后,联合组患者的PaO_(2)、GCQ中心理精神、生理、社会文化、环境4个维度评分均高于常规组,差异均有统计学意义(t分别=-2.75、-2.05、-3.24、-2.80、-3.09,P均<0.05);联合组患者的PaCO_(2)、Raw、mPaw、Pplat、mMRC、CAT、SGRQ中呼吸症状、活动能力、日常受疾病影响评分均低于常规组(t分别=3.15、2.11、2.16、2.64、2.97、2.11、3.09、3.19、2.12,P均<0.05);两组并发症总发生率比较(4.65%vs.13.95%),差异无统计学意义(χ^(2)=2.81,P>0.05)。结论四级锻炼结合集束化干预有助于AECOPD机械通气患者改善血气状态、呼吸力学参数,减轻呼吸困难程度,提高护理舒适度,提升生活质量。

Objective To investigate the influence of four-stage exercise combined with bundled intervention on blood gas indicators and respiratory mechanics parameters in patients with acute exacerbation of chronic obstructive pulmonary disease(AECOPD)undergoing mechanical ventilation.Methods A total of 86 patients with AECOPD undergoing mechanical ventilation admitted from January 2021 to September 2023 were enrolled and divided into conventional group and combined group according to the random number table method,with 43 cases in each group.The conventional group was received conventional nursing and rehabilitation training intervention,while the combined group was received fourstage exercise combined with bundled intervention on the basis of the conventional group.The blood gas indicators[arterial partial pressure of carbon dioxide(PaCO_(2)),arterial partial pressure of oxygen(PaO_(2)),oxygenation index PaO_(2)/FiO_(2)],respiratory mechanics parameters[airway resistance(Raw),mean airway pressure(mPaw),airway platform pressure(Pplat)],dyspnea status[modified dyspnea questionnaire(mMRC),chronic obstructive pulmonary disease assessment test(CAT)],mechanical ventilation-related complications,nursing comfort[general comfort questionnaire(GCQ)]and quality of life[St.George’s respiratory questionnaire(SGRQ)]were compared between the two groups before and after intervention.Results After intervention,the PaO_(2) and GCQ score of patients in the combined group were higher than those in the conventional group,with statistical significance(t=-2.75,-2.05,-3.24,-2.80,-3.09,P<0.05).The PaCO_(2),Raw,mPaw,Pplat,mMRC,CAT and scores of respiratory symptom,activity ability and daily disease influence of SGRQ in the combination group were lower than those in the conventional group(t=3.15,2.11,2.16,2.64,2.97,2.11,3.09,3.19,2.12,P<0.05).There was no significant difference in the total incidence of complications between the two groups(4.65%vs.13.95%)(χ^(2)=2.81,P>0.05).Conclusion Four-stage exercise combined with bundled intervention can help AECOPD patients with mechanical ventilation to improve blood gas status and respiratory mechanics parameters,relieve dyspnea,improve nursing comfort and quality of life.