AECOPD机械通气患者早期拔管后肺康复锻炼的依从性调查及影响因素

Investigation and influencing factors of pulmonary rehabilitation exercise compliance in patients with AECOPD after mechanical ventilation and early extubation

目的调查了解慢性阻塞性肺疾病急性加重期(acute exacerbation of chronic obstructive pulmonary disease,AECOPD)机械通气患者早期拔管后的肺康复锻炼依从性,分析其影响因素,以期改善预后。方法统计106例AECOPD机械通气患者早期拔管后肺康复锻炼依从性,采用多因素回归分析影响AECOPD机械通气患者早期拔管后肺康复锻炼依从性的因素,并构建风险预测模型。结果106例AECOPD机械通气患者肺康复锻炼依从性评分为(4.41±1.16)分,其中>5分45例(42.45%),≤5分61例(57.55%);多因素Logistic分析结果显示,初中及以下文化程度(OR=4.438,P=0.012)、吸烟史(OR=3.700,P=0.031)、病程≤5年(OR=3.985,P=0.016)、药物依赖(OR=13.911,P=0.003)、负性情绪(OR=8.680,P=0.001)、MST评分≥2分(OR=11.190,P=0.001)均为影响AECOPD机械通气患者早期拔管后肺康复锻炼依从性的独立因素;构建AECOPD机械通气患者早期拔管后肺康复锻炼依从性的风险预测模型,Hosmer-Lemeshow检验显示拟合度好(χ^(2)=7.026,P=0.426),预测模型的AUC为0.890。结论文化程度、吸烟史、病程、药物依赖、负性情绪均可影响AECOPD机械通气患者早期拔管后肺康复锻炼依从性,临床可进行早期预防和干预以提高锻炼依从性。

Objective To investigate and understand the compliance with pulmonary rehabilitation exercises in patients with acute exacerbation of chronic obstructive pulmonary disease(AECOPD)after early weaning from mechanical ventilation,and to analyze the influencing factors,with the aim of improving outcomes.Methods A total of 106 patients with AECOPD undergoing mechanical ventilation were statistically analyzed for their compliance of pulmonary rehabilitation exercise after early extubation.Multifactorial regression analysis was employed to identify factors influencing the compliance with post-weaning pulmonary rehabilitation exercises in AECOPD patients on mechanical ventilation,and a risk prediction model was constructed.Results In the 106 patients with AECOPD after mechanical ventilation,compliance score of pulmonary rehabilitation exercise was(4.41±1.16)points,with 45 cases(42.45%)scoring>5 points and 61 cases(57.55%)scoring≤5 points.Multivariate Logistic analysis showed that education level of junior high school or below(OR=4.438,P=0.012),smoking history(OR=3.700,P=0.031),disease duration≤5 years(OR=3.985,P=0.016),drug dependence(OR=13.911,P=0.003),negative emotion(OR=8.680,P=0.001),and Mini Nutritional Assessment(MST)score≥2 points(OR=11.190,P=0.001)were independent risk factors of pulmonary rehabilitation exercise compliance.An independent risk prediction model for the compliance with pulmonary rehabilitation exercises among AECOPD mechanically ventilated patients after early extubation was constructed.The model's predictive performance was validated using the Hosmer-Lemeshow test(χ^(2)=7.026,P=0.426),with an area under the curve(AUC)of 0.890.Conclusions Education level of junior high school or below,smoking history,course of disease≤5 years,drug dependence and negative emotion are independent risk factors of pulmonary rehabilitation exercise compliance in patients with AECOPD after mechanical ventilation and early extubation.Early prevention and intervention strategies can be implemented clinically to improve exercise compliance.