早期肺康复训练在有创机械通气患者中的应用效果

摘要

Objective To investigate the effects of early rehabilitation therapy in mechanically ventilated pa-tients in ICU. Methods A randomized controlled trial was carried out. Forty-eight mechanically ventilated patients ad-mitted to the Intensive Care Unit of the Affiliated Hospital of Hainan Medical University from Jan. 2014 to Sep. 2015 were randomly divided into two groups:the rehabilitation group (n=23) and the control group (n=25). The control group applied routine treatment and nursing. In rehabilitation group, rehabilitation therapy was taken twice daily. Days to first out of bed, duration of mechanical ventilation, ICU stay, APACHE Ⅱ score, the hospitalization expense and hospital mortality of patients were compared between rehabilitation group and control group. Results There was no significant difference in APACHE Ⅱ score and hospital mortality between rehabilitation group and control group, (10.0 ± 2.8) vs (9.9±3.0), 13.0%vs 16.0%, P>0.05. Days to first out of bed, duration of mechanical ventilation and ICU stay of rehabili-tation group were shorter compared with those of control group, (6.2 ± 1.7) d, (6.2 ± 2.3) d, (11.5 ± 3.8) d vs (12.5 ± 4.6) d, (8.1±3.2) d, (14.7±4.2) d, and the hospitalization expense was decreased, (10.7±21)×104 Yuan vs (13.7±3.5)×104 Yuan, P<0.05. Conclusion Early rehabilitation therapy is safe and effective, with shorter duration of mechanical ventilation and ICU stay, decreased hospitalization expense, which is beneficial to the early recovery of pulmonary function.%目的 探讨重症监护室(ICU)内机械通气患者进行院内早期肺康复训练的临床应用效果.方法 采用前瞻性随机对照实验研究,选择2014年1月至2015年9月在海南医学院附属医院重症医学科收治行机械通气的48例患者,根据随机数字表法分为观察组(n=23)和对照组(n=25),对照组采用常规治疗和护理,观察组患者在对照组的基础上每日进行两次肺康复训练,比较两组患者的首次床旁坐位时间、机械通气时间、ICU住院时间、出院时急性生理与慢性健康评分(APACHEII)评分、住院总费用和住院病死率.结果 观察组患者出院时的APACHEII评分、住院病死率分别为(10.0±2.8)分、13.0%,对照组分别为(9.9±3.0)分、16.0%,两组比较差异均无统计学意义(P>0.05);观察组患者首次床旁坐位时间、机械通气时间、ICU住院时间、住院费用分别为(6.2±1.7)d、(6.2+2.3)d、(11.5±3.8)d、(10.7±2.1)万元,较对照组的(12.5±4.6)d、(8.1±3.2)d、(14.7±4.2)d、(13.7±3.5)万元明显减少,差异均有统计学意义(P<0.05).结论 在掌握严格适应证的情况下,机械通气患者行早期肺康复训练是安全有效的,可缩短患者机械通气时间和ICU住院时间,减少住院费用,有利于肺功能的早期恢复.