摘要
目的探讨基于信息化的阶梯式重症康复治疗对慢性阻塞性肺疾病急性加重期(AECOPD)患者的影响。方法将80例入住重症监护病房(ICU)的AECOPD患者按照随机数字表法分为对照组和观察组,每组40例。对照组进行常规重症康复治疗,观察组进行基于信息化的阶梯式重症康复治疗。入科及转出ICU时,对2组患者的第1秒用力呼气容积(FEV1)、用力肺活量(FVC)、FEV1/FVC、膈肌功能进行比较。记录康复相关指标、机械通气时长、呼吸机相关肺炎(VAP)发生率、ICU停留时长、谵妄发生率、深静脉血栓(DVT)发生率、转出后再次入住ICU的患者例数和住院28 d死亡率。结果与组内入科时比较,2组患者转出ICU时的肺功能、膈肌功能、康复相关指标、住院相关指标均有不同程度的改善(P<0.05)。与对照组转出ICU时同指标比较,观察组的FEV1[(1.76±0.12)L]、FVC[(2.13±0.19)L]、FEV1/FVC[(60.8±5.7)%]、吸气末膈肌厚度[(27.8±2.4)mm]、呼气末膈肌厚度[(20.3±2.0)mm]、膈肌增厚率[(39.7±12.4)%]改善更为优异(P<0.05)。观察组的康复中断时长[(50.4±5.4)min]、意外拔管发生率(5.0%)、机械通气时长[(7.4±2.0)d]、VAP发生率(7.5%)、ICU停留时长[(10.6±2.7)d]、谵妄发生率(5.0%)、DVT发生率(7.5%)均较对照组低(P<0.05),单日康复时长[(75.1±15.2)min]和mMRC呼吸问卷≥2级达成率(90.0%)均较对照组高(P<0.05)。2组患者的住院28 d死亡率比较,差异无统计学意义(P>0.05)。结论对入住ICU的AECOPD患者进行基于信息化的阶梯式重症康复治疗,能有效改善其肺功能和膈肌功能,减少机械通气时间和ICU停留时间,降低住院期间VAP和DVT的发生率。
Objective To document the impact of information-based,stepwise,intensive rehabilitation therapy on patients with acute exacerbation of chronic obstructive pulmonary disease(AECOPD).Methods Eighty such patients in an intensive care unit(ICU)were randomly divided into a control group and an observation group,each of 40.The control group received routine ICU rehabilitation,while the observation group underwent information-based,step-wise ICU rehabilitation.Upon admission to and discharge from the ICU,the forced expiratory volume in 1 second(FEV1),forced vital capacity(FVC),FEV1/FVC,and diaphragm functioning were compared between the two groups.The duration of mechanical ventilation,the incidence of ventilator-associated pneumonia(VAP),length of stay in the ICU,incidence of delirium,and the incidence of deep vein thrombosis(DVT)were also recorded.The number of patients readmitted to the ICU after discharge,and the 28-day hospital mortality rate were recorded as well.Results Significant improvement was observed in both groups in terms of their lung and diaphragm functioning,as well as in the rehabilitation-and hospital-related indicators.At discharge,significantly greater improvements were observed in the observation group compared with the control group in terms of their average FEV1,FVC,FEV1/FVC,inspiratory and expiratory diaphragm thickness,and diaphragm thickening rate.The average duration of mechanical ventilation and of rehabilitation interruptions was significantly less in the observation group.And incidents of accidental extubation,VAP,delirium and DVT were significantly fewer in the observation group as well.Their ICU stays tended to be significantly shorter without any significant difference between the two groups in the 28-day hospital mortality rate.The control group spent significantly less time in their daily rehabilitation sessions,with the result that significantly fewer of them achieved a grading of 2 or better on the mMRC respiratory questionnaire.Conclusion Information-based stepwise intensive rehab
作者
富燕萍
王金柱
李淑燕
陈娟红
江玲芝
姚惠萍
叶祥明
Fu Yanping;Wang Jinzhu;Li Shuyan;Chen Juanhong;Jiang Lingzhi;Yao Huiping;Ye Xiangming(Department of Rehabilitation Medicine,Intensive Rehabilitation Unit,Zhejiang Provincial People's Hospital(Affiliated People's Hospital),Hangzhou Medical College,Hangzhou 310014,China;Intensive Care Unit,Zhejiang Provincial People's Hospital(Affiliated People's Hospital),Hangzhou Medical College,Hangzhou 310014,China)
出处
《中华物理医学与康复杂志》
CAS
CSCD
北大核心
2024年第11期1004-1010,共7页
Chinese Journal of Physical Medicine and Rehabilitation
基金
浙江省卫生健康科技计划(2022KY509,2021KY071)。
关键词
慢性阻塞性肺疾病急性加重期
重症康复
阶梯式
信息化
Chronic obstructive pulmonary disease
Intensive care rehabilitation
Stepwise rehabilitation
