重症急性呼吸窘迫综合征早期分阶段肺康复锻炼的疗效

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摘要目的探讨早期分阶段肺康复锻炼治疗重症急性呼吸窘迫综合征(acute respiratory distress syndrome,ARDS)的疗效。方法选取2018-01至2019-12武汉市第一医院重症ARDS 患者60例,采用随机数字表法分为对照组和观察组,每组30例。对照组实施常规治疗,观察组常规治疗基础上采用早期分阶段肺康复锻炼治疗,比较两组治疗前后肺通气功能指标、动脉血气状况指标和生存质量评分变化,记录两组机械通气时间、ICU治疗时间、住院时间、呼吸机相关性肺炎发生率。结果两组治疗后,1 s用力呼吸容积、1 s用力呼吸容积/肺活量比率和生存质量评分均较治疗前明显改善,PaO₂、SpO₂和氧合指数均较治疗前升高,差异有统计学意义(P<0.05)。且观察组PaCO₂低于对照组[(44.18±5.06)mmHg vs. (49.47±5.24)mmHg],呼吸机通气时间[(2.74±0.90)d vs. (3.98±1.22)d]、ICU治疗时间[(3.19±1.03)d vs. (4.27±1.15)d]和住院时间[(10.98±2.13)d vs. (13.76±2.69)d]均短于对照组,差异有统计学意义(P<0.05)。观察组呼吸机相关性肺炎发生率低于对照组(3.33% vs 20.00%),差异有统计学意义(P<0.05)。结论在常规治疗基础上加用早期分阶段肺康复锻炼对治疗重症ARDS安全有效。

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	欧阳方
	何娟
	马艳

关键词 ：早期分阶段, 急性呼吸窘迫综合征, 肺康复锻炼, 氧合指数, 呼吸机相关性肺炎

Abstract：Objective To observe the efficacy of early staged lung rehabilitation exercise in patients with severe acute respiratory distress syndrome (ARDS). Methods A total of 60 patients with severe ARDS treated in our hospital between January 2018 and December 2019 were selected. They were randomly divided into the control group and test group, with 30 cases in each. The control group received conventional treatment while the test group was additionally subjected to early staged lung rehabilitation exercise. The changes of pulmonary ventilation function, arterial blood gas indexes and scores of quality of life were observed before and after treatment and compared between the two groups after treatment. The duration of mechanical ventilation, ICU stay, hospital stay and the incidence of ventilator-associated pneumonia were recorded. Results After treatment, the forced expiratory volume in 1 second (FEV₁), the FEV₁/forced vital capacity ratio and scores of quality of life were all improved, while PaO₂, SpO₂ and oxygenation indexes were increased in both groups (P<0.05), especially in the test group (P<0.05). Levels of PaO₂ [(44.18±5.06) vs (49.47±5.24)] were lower in the test group than in the control group (P<0.05).The duration of mechanical ventilation [(2.74±0.90) vs (3.98±1.22)], ICU stay [(3.19±1.03) vs (4.27±1.15)] and hospital stay [(10.98±2.13) vs (13.76 ±2.69)] were shorter (P<0.05) and the incidence of ventilator-associated pneumonia was lower in the test group (3.33% vs 20.00%) (P<0.05). Conclusions The combination of conventional treatment, with early staged lung rehabilitation exercise can more effectively improve the pulmonary ventilation function, reduce the risk of ventilator-associated pneumonia and improve the quality of life among patients with severe ARDS.

Key words： early staged acute respiratory distress syndrome lung rehabilitation exercise oxygenation index ventilator-associated pneumonia

收稿日期: 2021-04-21

ZTFLH:

R493

通讯作者: 马艳,E-mail:ajuan311@qq.com

作者简介: 欧阳方,硕士,主治医师。

引用本文:

欧阳方, 何娟, 马艳. 重症急性呼吸窘迫综合征早期分阶段肺康复锻炼的疗效[J]. 武警医学, 2021, 32(11): 937-941. OU Yangfang, HE Juan, MA Yan. Effect of early staged lung rehabilitation exercise in patients with severe ARDS. Med. J. Chin. Peop. Armed Poli. Forc., 2021, 32(11): 937-941.

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http://journal08.magtechjournal.com/Jwk_wjyx/CN/ 或 http://journal08.magtechjournal.com/Jwk_wjyx/CN/Y2021/V32/I11/937

[1]	Elena S, Tommaso M, Eleonora C, et al. Time-course of physiologic variables during extracorporeal membrane oxygenation and outcome of severe acute respiratory distress syndrome[J]. ASAIO J, 2020, 66(6): 663-670.
[2]	Stavros D, Kostas S, Serafim N, et al. Quantifying lung recruitment and lung recovery in acute respiratory distress syndrome patients with venovenous extracorporeal membrane oxygenation support[J]. Crit Care Med, 2020, 48(4): e343-e344.
[3]	Giacomo G, Luigi C, Nicola B, et al. Practical clinical application of an extracorporeal carbon dioxide removal system in acute respiratory distress syndrome and acute on chronic respiratory failure[J]. ASAIO J, 2020, 66(6): 691-697.
[4]	郝宏伟.急性呼吸窘迫综合征危重患者早期分阶段康复护理方案的应用价值[J]. 辽宁医学, 2019, 33(5): 78-80.
[5]	中华医学会重症医学分会.急性肺损伤/急性呼吸窘迫综合征诊断和治疗指南(2006)[C]//中华医学会重症医学基本理论与基本技能研讨会. 2007.
[6]	都元涛,方积乾.世界卫生组织生存质量测定量表中文版介绍及其使用说明[J]. 现代康复, 2000, 4(8): 1127-1129.
[7]	Zampieri F G, Póvoa P, Salluh J I, et al. Lower respiratory tract infection and short-term outcome in patients with acute respiratory distress syndrome[J]. J Intensive Care Med, 2020, 35(6): 588-594.
[8]	Soo J N, Jeon K. Extracorporeal membrane oxygenation support in adult patients with acute respiratory distress syndrome[J]. Expert Rev Respir Med, 2020, 14(5): 511-519.
[9]	Tabatabai A,Menaker J, Stene E, et al. Methylprednisolone may be associated with improved lung compliance in acute respiratory distress syndrome patients on veno-venous extracorporeal membrane oxygenation[J]. Perfusion, 2020,35(6): 515-520.
[10]	曾洁仪. 重症急性呼吸窘迫综合征患者进阶式早期肺康复锻炼的效果观察[J]. 护理实践与研究, 2018, 15(3): 34-36.
[11]	Harischandra T,Withana K. Successful use of extracorporeal membrane oxygenation in acute respiratory distress syndrome following accidental chlorine gas inhalation at a swimming pool[J]. Perfusion, 2020, 35(6): 543-545.
[12]	盘健,马君武,邓秀凡,等.压力释放通气模式与肺保护性通气治疗急性呼吸窘迫综合征的对比研究[J]. 中国当代医药, 2018, 25(9): 43-45.
[13]	龚晓露.阶梯式肺康复护理对重症急性呼吸窘迫综合征患者预后的影响[J]. 河南医学研究, 2020, 29(18): 3448-3449.
[14]	芮萌,段蕴铀.慢性阻塞性肺疾病肺康复研究进展[J].武警医学,2020,31(5):441-445.
[15]	Walsh C J, Batt J, Herridge M S, et al.Muscle wasting and early mobilization in acute respiratory distress syndrome[J].Clin Chest Med, 2014, 35(4):811-826.
[16]	齐英娜.早期分阶段肺康复锻炼在急性呼吸窘迫综合征患者中的应用效果[J]. 医疗装备, 2020, 33(8): 154-155.
[17]	梁泽平,商璀, 蒋东坡,等. 早期分阶段肺康复锻炼技术在ARDS重症患者护理中的应用[J]. 护理研究, 2017, 31(8): 955-958.
[18]	施惠,范晓春,陆肖娴.基于氧合指数指导下的进阶式肺康复训练在急性呼吸窘迫综合征患者的中应用[J]. 医学临床研究, 2019, 36(11): 2225-2227.
[19]	刁毅.早期分阶段肺康复锻炼技术对重症监护病房(ICU)急性呼吸窘迫综合征(ARDS)患者治疗效果的影响分析[J].心血管外科杂志(电子版),2018,7(2):259-260.
[20]	张志俊,张良平,潘峥强,等.早期分阶段肺康复锻炼治疗重症急性呼吸窘迫综合征的临床研究[J].中西医结合心血管病电子杂志,2019,7(33):128.
[21]	武士龙,谢来华,李万鹏,等.分阶段肺康复锻炼治疗重症ARDS患者临床疗效及并发症情况观察[J].黑龙江医药,2019,32(6):1479-1480.
[22]	徐小莉,蒋珊珊.早期分阶段肺康复锻炼治疗重症ARDS的效果观察[J].中外医学研究,2020,18(21):176-178.
[23]	Gimigliano F, Negrini S. The world health organization“rehabilitation 2030: a call for action”[J]. Eur J Phys Rehabil Med,2017,53(2): 155-168.
[24]	Davydow D S, Desai S V, Needham D M, et al.Psychiatric morbidity in survivors of the acute respiratory distress syndrome:a systematic review[J].Psychosom Med, 2008, 70(4):512-519.