肺康复对呼吸机相关性肺炎治疗的影响

Effect of pulmonary rehabilitation on treatment of ventilatorassociated pneumonia

摘要:

目的 探讨肺康复对呼吸机相关性肺炎的治疗效果及安全性评价。方法 选取符合条件的80例有 创机械通气且确诊为呼吸机相关性肺炎患者，按随机数字表法分为对照组与康复组，各40例。对照组采用常规治 疗，康复组在对照组治疗基础上进行肺康复干预，分析两组患者重症监护治疗病房（ICU）住院时间、机械通气时 间、治疗前后急性生理学及慢性健康状况评分系统（APACHEⅡ）评分、最低氧分压/吸氧浓度（PaO2/FiO2）、各炎 症指标变化、临床肺部感染评分（CPIS）和治疗总有效率。结果 康复组平均ICU住院时间、机械通气时间短于对 照组（P <0.05）；干预7 d后，两组患者APACHEⅡ评分、白细胞（WBC）计数、降钙素原（PCT）、C反应蛋白（CRP）、 CPIS均较治疗前降低（P <0.05），最低PaO2/FiO2较治疗前提高（P <0.05）；康复组APACHEⅡ评分、WBC计数、 PCT、CRP、CPIS 低于对照组（P <0.05），最低PaO2/FiO2高于对照组（P <0.05），治疗总有效率高于对照组 （92.50% VS 70.00%）（P <0.05）。康复组无不良事件发生。结论 肺康复治疗降低呼吸机相关性肺炎炎性指标水 平、缩短机械通气时间和ICU住院时间，提高治疗总有效率，安全性较高，值得临床推广应用。

Abstract:

Objective To investigate the effect of pulmonary rehabilitation therapy on patients with ventilation-associated pneumonia, and to evaluate the safety of rehabilitation therapy on patients with invasive mechanical ventilation with ventilation-associated pneumonia. Methods A total of 80 qualified cases with invasive mechanical ventilation and confirmed ventilator-associated pneumonia were randomly divided into control group and rehabilitation group with 40 cases in each group. The control group was treated with routine treatment. The rehabilitation group received pulmonary rehabilitation on the basis of routine therapy. The hospitalized time in ICU and the duration of mechanical ventilation were compared. The acute physiology and chronic health evaluation scoring system score, minimum PaO2/FiO2, inflammatory indexes, clinical pulmonary infection score were compared before and after treatment, and the total effective rate was analyzed. Results The hospitalized time in ICU and the duration of mechanical ventilation of rehabilitation group were shorter than those of control group. After 7-day treatment, APACHE Ⅱ score, white blood cell (WBC) count, calcitonin (PCT), C-reactive protein (CRP) and clinical pulmonary infection score (CPIS) in two groups decreased (P < 0.05), and minimum PaO2/FiO2 improved, compared with those before treatment (P < 0.05). After treatment, APACHE Ⅱ score, WBC, PCT, CRP and CPIS in rehabilitation group were lower than those in control group (P < 0.05), and minimum PaO2/ FiO2 in rehabilitation group was higher than that in control group. The total effective rate of the rehabilitation group was higher than that of control group (92.50% VS 70.00%) with significant difference (P < 0.05). No adverse event occurred in rehabilitation group. Conclusion Pulmonary rehabilitation therapy can reduce the inflammatory index of patients with ventilator-associated pneumonia, shorten the time of mechanical ventilation and ICU hospitalization, improve the total effective rate, and have high security, which is worthy of promotion.