摘要
目的构建重症监护病房(ICU)机械通气患者中西医结合呼吸康复方案,并验证其临床应用效果。方法在文献分析和专家函询的基础上构建ICU机械通气患者中西医结合呼吸康复方案。选取2024年10月至12月在成都中医药大学附属医院ICU住院的48例机械通气患者作为研究对象,按非同期前后对照法分为试验组和对照组。对照组接受常规康复措施,试验组在接受常规康复措施的基础上实施中西医结合的呼吸康复方案。比较两组患者最大吸气压(MIP)、咳嗽峰流速(PCF)、膈肌厚度、膈肌移动度、肺部感染发生率、机械通气时间、满意度等方面的差异。结果专家函询共进行了2轮,有效问卷回收率达到100%,函询的专家权威系数分别为0.86、0.89,第2轮函询后总体方案的肯德尔协调系数为0.627(P<0.05),形成呼吸康复措施实施前、实施期间和出院/转科后持续呼吸康复3个阶段的方案。最终纳入患者试验组23例,对照组21例。试验组肺部感染发生率明显低于对照组[82.6%(19/23)比90.5%(19/21),P<0.05]、满意度明显高于对照组[95.7%(22/23)比52.4%(11/21),P<0.05],MIP、PCF、膈肌厚度、膈肌移动度、肌力分级均明显高于对照组[MIP(cmH_(2)O,1 cmH_(2)O≈0.098 kPa):-22.43±16.93比-10.95±7.02,PCF(L/min):87.76±22.95比56.08±7.58,膈肌厚度(mm):2.36±0.22比1.73±0.60,膈肌移动度(cm):1.88±0.18比1.62±0.11,肌力分级(级):5.00(4.00,5.00)比2.00(1.00,3.00),均P<0.05]。结论该研究构建的机械通气患者中西医结合康复方案具有科学性和可行性,可改善患者的呼吸肌功能、咳嗽能力、提高患者的肌力、降低患者肺部感染发生率,增加患者的满意度,进而缩短临床康复周期。
Objective To develop an integrated traditional Chinese and Western medicine(TCWM)respiratory rehabilitation programme for patients undergoing mechanical ventilation in the intensive care unit(ICU)and to evaluate its clinical efficacy.Methods An integrated TCWM respiratory rehabilitation program for ICU patients on mechanical ventilation was developed based on literature analysis and expert consultations.A total of 48 patients undergoing mechanical ventilation in the department of ICU of the Affiliated Hospital of Chengdu University of Traditional Chinese Medicine from October to December 2024 were enrolled and divided into an experimental group and a control group using a non-concurrent controlled trial design.The control group received routine rehabilitation,while the experimental group implemented the integrated TCWM respiratory rehabilitation program in addition to routine care.The differences between the two groups in terms of maximal inspiratory pressure(MIP),peak cough flow(PCF),diaphragmatic thickness,diaphragmatic excursion,incidence of pulmonary infection,duration of mechanical ventilation and patient satisfaction were compared.Results Two rounds of expert consultations were conducted with a 100%effective questionnaire recovery rate.The authority coefficient(Cr)for the two rounds were 0.86 and 0.89,respectively.After the second round,the Kendall's W for the overall program was 0.627(P<0.05),resulting in a 3-stage respiratory rehabilitation program.Ultimately,23 cases in the experimental group and 21 cases in the control group were included.Compared to the control group,the experimental group showed significantly lower incidence of pulmonary infection[82.6%(19/23)vs.90.5%(19/21),P<0.05]and significantly higher satisfaction[95.7%(22/23)vs.52.4%(11/21),P<0.05],MIP,PCF,diaphragmatic thickness,diaphragmatic excursion and muscle strength grading in the experimental group were significantly higher than those in the control group[MIP(cmH_(2)O,1 cmH_(2)O≈0.098 kPa):-22.43±16.93 vs.-10.95±7.02,PCF(L/min):87.76±22.95 vs.56.08±7.58,diaphragmatic thickness(mm):2.36±0.22 vs.1.73±0.60,diaphragmatic excursion(cm):1.88±0.18 vs.1.62±0.11,muscle strength grade:5.00(4.00,5.00)vs.2.00(1.00,3.00),all P<0.05].Conclusions The integrated TCWM respiratory rehabilitation program developed in this study is scientific and feasible.It can effectively improve respiratory muscle function and coughing ability,enhance muscle strength,reduce the incidence of pulmonary infection,and increase patient satisfaction,thereby shortening the clinical recovery period.
作者
黄燕
蒋瑞琪
陈志友
黄良锐
严章荣
魏涛
陈有媛
岳燕
Huang Yan;Jiang Ruiqi;Chen Zhiyou;Huang Liangrui;Yan Zhangrong;Wei Tao;Chen Youyuan;Yue Yan(Department of Critical Care Medicine,Hospital of Chengdu University of Traditional Chinese Medicine,,Chengdu 610072,Sichuan,China)
出处
《中国中西医结合急救杂志》
2025年第5期604-610,共7页
Chinese Journal of Integrated Traditional and Western Medicine in Intensive and Critical Care
基金
国家中医优势专科建设项目(2024-90-1063)
四川省中西医结合学会科研项目(ZXY2025018)。
关键词
重症监护病房
机械通气
呼吸康复
中西医结合
Intensive care unit
Mechanical ventilation
Respiratory rehabilitation
Integrated traditional Chinese and Western medicine
