中国呼吸与危重监护杂志

中国呼吸与危重监护杂志

早期康复治疗对老年重症肺炎机械通气患者并发症及预后的影响

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目的 探讨早期康复治疗对老年重症肺炎机械通气患者并发症及预后的影响。 方法 将符合入选标准的入院患者随机分为早期康复治疗组和对照组各 35 例。在相同常规治疗基础上,早期康复治疗组予以早期康复治疗,治疗方法包括运动疗法、电刺激疗法、吞咽治疗、咳嗽训练以及轮椅-床转移训练等,依据患者病情个体化选择训练方法。观察两组患者 ICU 获得性衰弱(ICU-AW)、呼吸机相关性肺炎(VAP)、谵妄发生率、机械通气时间、ICU 住院时间、总住院时间、30 天住院病死率、拔管失败率、气管切开率的差异。 结果 与对照组比较,康复治疗组患者 ICU-AW(14.28% 比 37.14%)、VAP(8.57% 比 28.57%)、谵妄(40.00% 比 65.71%)等并发症发生率明显降低(均 P<0.05),谵妄持续时间[(3.50±1.31)d 比(6.40±1.47)d],机械通气时间[(6.32±2.19)d 比(9.40±4.43)d]、ICU 住院时间[(10.80±3.64)d 比(15.31±3.85)d]、总住院时间[(22.52±7.56)d 比(30.22±11.54)d]显著缩短(均P<0.001),气管切开率(25.71% 比 51.42%)及 30 天住院病死率(28.57% 比 54.28%)显著降低(均P<0.05),气管拔管失败率差异无统计学意义(5.71% 比 11.42%,P>0.05)。早期康复治疗组患者未出现管道脱出、肢体损伤及严重心律失常等并发症。 结论 早期康复治疗能够降低老年重症肺炎机械通气患者 ICU-AW、VAP、谵妄等并发症的发生率,有利于缩短机械通气时间、ICU 住院时间、总住院时间及气管切开率,安全有效,值得临床 ICU 推广应用。

Objective To explore the effect of early rehabilitation treatment on complications and prognosis of elderly patients with sever pneumonia undergoing mechanical ventilation. Methods The patients who meeting the inclusion criteria were randomly divided into an early rehabilitation group and a control group, with 35 cases in each group. On basis of same routine treatment, the early rehabilitation group was treated with early rehabilitation. The early rehabilitation methods included exercise therapy, electrical stimulation therapy, swallowing therapy, cough training and wheelchair-bed transfer training, etc. The patients received individual training methods according to their conditions. The difference of two groups were observed in the rates of ICU-acquired weakness (ICU-AW), ventilator-associate pneumonia (VAP), the incidence of delirium, the mechanical ventilation time, ICU-hospital time, total hospital time, 30-day hospital mortality, extubation fail rate and tracheotomy rate. Results Compare with the control group, the incidence of ICU-AW (14.28% vs. 37.14%), VAP (8.57% vs. 28.57%), and delirium (40.00% vs. 65.71%) in the early rehabilitation group were significantly reduced (all P<0.05). The duration of delirium [(3.50±1.31) dvs. (6.40±1.47) d], the ventilation time [(6.32±2.19) d vs. (9.40±4.43) d], ICU hospitalization time [(10.80±3.64) d vs. (15.31±3.85) d] and total hospitalization time [(22.52±7.56) d vs. (30.22±11.54) d] of the early rehabilitation group were significantly lower than the control group (all P<0.001). The tracheotomy rate and 30-day hospital mortality of the early rehabilitation group were significantly lower than the control group (25.71%vs. 51.42% and 28.57% vs. 54.28%, both P<0.05). There was no significant difference in extubation fail rate (5.71%vs. 11.42%, P>0.05). In the early rehabilitation group, there were no complications such as pipe prolapse, limb injury or serious arrhythmia. Conclusion Early rehabilitation can reduce the incidence of ICU-AW, VAP, delirium in elderly patients with severe pneumonia, help to shorten the mechanical ventilation time, ICU hospitalization time and total hospitalization time, reduce extubation failure rate and tracheotomy rate, so it is safe and effective, and worthy of being popularized and applied.

关键词: 早期康复治疗; 老年; 重症肺炎; 机械通气

Key words: Early rehabilitation therapy; Elderly patients; Severe pneumonia; Mechanical ventilation

引用本文: 李大亮, 黄雪敏, 岑树坤, 蒙自杰, 严海燕, 陶珍凤. 早期康复治疗对老年重症肺炎机械通气患者并发症及预后的影响. 中国呼吸与危重监护杂志, 2018, 17(1): 46-50. doi: 10.7507/1671-6205.201707047 复制

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