一体化康复管理方案在重症机械通气患者中的应用

Application of integrated rehabilitation management program in severe patients with mechanical ventilation

目的 研究一体化康复管理方案在重症机械通气患者中的应用效果。方法 纳入2021年1月至2022年6月收治的实施机械通气治疗的重症患者150例为研究对象,随机分为观察组与对照组,每组75例。对照组实施常规重症机械通气干预,观察组患者实施一体化康复管理方案。比较2组患者呼吸机相关事件发生率、机械通气相关指标、肌力情况、镇静情况、血栓发生率、获得性衰弱率的差异。结果 干预后2组患者潮气量均增加,呼吸频率与呼吸阻力均下降,且观察组变化大于对照组(P<0.05);干预后2组患者的氧分压与氧合指数/吸入氧浓度均增高,二氧化碳分压均下降,且观察组变化大于对照组(P<0.05);干预后2组肌力均增加,观察组肌力高于对照组(P<0.05);观察组患者的浅镇静率高于对照组,谵妄发生率低于对照组(P<0.05);观察组患者机械通气时间、ICU住院时间短于对照组,获得性衰弱及并发症率低于对照组(P<0.05)。结论 一体化康复管理方案能够降低重症机械通气患者并发症率与获得性衰弱风险,提高患者呼吸功能、肌力水平与镇静效果,优化患者预后。

Objective To study the effect of integrated rehabilitation management program in severe patients with mechanical ventilation.Methods A total of 150 severe patients with mechanical ventilation from January 2021 to June 2022 were enrolled in the study,they were randomly divided into the observation group(n=75) and the control group(n=75) by a digital table.The patients group received routine intervention,and the patients in the observation group received integrated rehabilitation management program.The incidence of ventilator-associated events,mechanical ventilation related indicators,muscle strength,sedation,incidence of thrombosis and acquired weakness were compared between groups.Results After intervention,the tidal volume in both groups was significantly increased than that before intervention,but respiratory frequency and respiratory resistance were significantly decreased(P<0.05),and which were greater in the observation group than in the control group(P<0.05).The oxygen partial pressure and oxygen saturation/fraction of inspired oxygen were significantly higher,but partial pressure of carbon dioxide was significantly lower,the improvements were more in the observation group than in the control group(P<0.05).The muscle strength in both groups was significantly higher,which in the observation group was significantly higher relative to the control group(P<0.05).The shallow sedation rate in the observation group was significantly higher than that of the control group,but the incidence of delirium was significantly lower(P<0.05).The duration of mechanical ventilation and intensive care unit(ICU) hospitalization in the observation group were significantly shorter than those of the control group,but the rates of acquired weakness and complications in the observation group were significantly lower than those of the control group(P<0.05).Conclusion The integrated rehabilitation management program can reduce the complication rate and the risk of acquired weakness in severe patients with mechanical ventilation,improve the respiratory function,muscle strength and sedation effect,and optimize the prognosis of patients.