摘要
目的研究Acapella对拔管后慢性阻塞性肺疾病急性加重期(acute exacerbation of chronic obstructive pulmonary disease,AECOPD)患者肺功能和预后的影响。方法选择2016年1月至2019年1月于南京医科大学附属常州第二人民医院行机械通气治疗好转后拔管的118例AECOPD患者为研究对象,按照随机数字表法将其分为观察组和对照组,每组各59例。对照组患者采用传统呼吸训练方法进行肺康复训练,观察组患者采取传统呼吸训练方法联合Acapella进行肺康复训练。比较两组患者训练前后血气分析指标、肺功能指标和6 min步行试验结果,并统计两组患者住院期间再插管率、日均排痰量、呼吸重症监护室(respiratory intensive care unit,RICU)入住天数。结果训练前和训练3 d时,两组患者动脉血二氧化碳分压(partial pressure of carbon dioxide in arterial blood,PaCO2)、动脉血氧分压(partial pressure of oxygen in arterial blood,PaO2)比较差异均无统计学意义(均P>0.05)。训练6 d和28 d时,观察组患者PaCO2均显著低于同期对照组(均P<0.05),PaO2均显著高于同期对照组(均P<0.05)。两组患者训练前后pH比较差异均无统计学意义(均P>0.05)。训练前、训练3 d和6 d时,两组患者用力肺活量(forced vital capacity,FVC)、第1秒用力呼气容积(forced expiratory volume in one second,FEV1)、一秒率(FEV1/FVC)比较差异均无统计学意义(均P>0.05),训练28 d时,观察组患者FVC、FEV1、FEV1/FVC均显著高于对照组(均P<0.05)。训练前,两组患者最大呼气中期流量(maximal mid-expiratory flow,MMEF)、最大呼气流量(maximal expiratory flow,MEF)和6 min步行距离比较差异均无统计学意义(均P>0.05),训练3 d、6 d和28 d时,观察组患者MMEF、MEF和6 min步行距离均显著大于对照组(均P<0.05)。观察组患者日均排痰量显著多于对照组(P<0.001),RICU入住天数显著短于对照组(P<0.001),两组患者再插管率比较差异无统计学意义(P=0.142)。结论拔管后AECOPD患者借助Acapella进行肺康复训练,可以明显改善其肺功能和运动能力,提高治疗效果。
Objective To study the effect of Acapella on pulmonary function and prognosis in patients with acute exacerbation of chronic obstructive pulmonary disease(AECOPD).Method A total of 118 AECOPD patients who underwent extubation after mechanical ventilation in Changzhou Second People's Hospital Affiliated to Nanjing Medical University from January 2016 to January 2019 were divided into observation group(n=59)and control group(n=59)according to the random number table method.The patients in control group used traditional respiratory training methods for pulmonary function training,and the patients in observation group adopted the traditional respiratory training combined with Acapella for pulmonary function training.The blood gas analysis indexes,pulmonary function indexes and the results of 6-min walking test were compared between the two groups before and after training,and the re-intubation rate,mean daily sputum output and respiratory intensive care unit(RICU)stay day were calculated between the two groups.Result Before training and on the 3rd day of training,there were no significant differences in partial pressure of carbon dioxide in arterial blood(PaCO2)and partial pressure of oxygen in arterial blood(PaO2)between the two groups(all P>0.05).On the 6th and 28th day of training,the PaCO2 of observation group were significantly lower than those of control group(all P<0.05),and the PaO2 of observation group were significantly higher than those of control group(all P<0.05).There were no significant difference in pH between the two groups before and after training(all P>0.05).Before training,on the 3rd and 6th day,there were no significant differences in forced vital capacity(FVC),forced expiratory volume in one second(FEV1)and FEV1/FVC between the two groups(all P>0.05).On the 28th day of training,FVC,FEV1 and FEV1/FVC of observation group were significantly higher than those of control group(all P<0.05).Before training,there were no significant differences in maximal midexpiratory flow(MMEF),maximal expiratory flow(MEF)and 6 min walking distance between the two groups(all P>0.05).On the 6th and 28th day of training,MMEF,MEF and 6 min walking distances of observation group were significantly higher than those of control group(all P<0.05).The mean daily sputum output of observation group was significantly more than that of control group(P<0.001),the RICU stay day of observation group was significantly shorter than that of control group(P<0.001).There was no significant difference in the re-intubation rate between the two groups(P=0.142).Conclusion Pulmonary function rehabilitation training combined with Acapella in AECOPD patients after extubation can significantly improve their pulmonary function and exercise ability,and improve the therapeutic effect.
作者
刘清
孙志琴
张倩
Liu Qing;Sun Zhiqin;Zhang Qian(Department of Respiratory,Changzhou Second People's Hospital Affiliated to Nanjing Medical University,Jiangsu,Changzhou 213000,China;Department of Infectious Diseases,Changzhou Second People's Hospital Affiliated to Nanjing Medical University,Jiangsu,Changzhou 213000,China)
出处
《中国医学前沿杂志（电子版）》
2020年第7期146-150,共5页
Chinese Journal of the Frontiers of Medical Science(Electronic Version)
基金
江苏省第五期“333工程”科研项目(BRA2016119)
“六大人才高峰”第十二批高层次人才选拔培养资助项目(WSN-092)。
关键词
慢性阻塞性肺疾病急性加重期
肺功能
康复训练
Acapella
Acute exacerbation of chronic obstructive pulmonary disease
Pulmonary function
Rehabilitation training
Acapella
