分阶段肺康复锻炼在成人急性呼吸窘迫综合征患者中的应用效果观察

doi:10.3760/cma.j.cn441417-20240708-01027

摘要/Abstract

摘要：

目的　观察分阶段肺康复锻炼在成人急性呼吸窘迫综合征（ARDS）患者中的应用效果。方法　选取2022年1月至2024年1月郑州大学第二附属医院收治的78例成人ARDS患者作为研究对象，采用随机数字表法将患者分为对照组（39例）和观察组（39例）。对照组男20例，女19例；年龄26～75（50.59±3.78）岁；病因：急性休克12例，脓毒症7例，创伤9例，脂肪栓塞6例，重症胰腺炎5例；病情严重程度：轻度13例，中度15例，重度11例。观察组男21例，女18例；年龄25～74（50.64±3.82）岁；病因：急性休克13例，脓毒症6例，创伤10例，脂肪栓塞7例，重症胰腺炎3例；病情严重程度：轻度14例，中度16例，重度9例。对照组采用常规护理干预，观察组在对照组基础上采用分阶段肺康复锻炼干预。两组均持续干预至患者出院。比较两组护理满意度［郑州大学第二附属医院自制护理满意度调查表］，干预前后血气指标［二氧化碳分压（PaCO₂）、动脉血氧分压（PaO₂）、血氧饱和度（SaO₂）、］、肺功能［第1秒用力呼气容积（FEV₁）、用力肺活量（FVC）、呼气峰流速（PEF）、每分钟最大通气量（MVV）］、生活质量［健康调查简表（SF-36）］，干预期间并发症发生情况（呼吸机相关肺炎、压疮、谵妄及肌肉萎缩等）。采用独立样本t检验、配对t检验和χ²检验进行统计学分析。结果　干预后，观察组PaCO₂低于对照组［（48.31±2.59）mmHg（1 mmHg=0.133 kPa）比（53.26±2.77）mmHg］，PaO₂和SaO₂均高于对照组［（82.29±4.68）mmHg比（73.37±4.54）mmHg、（94.37±1.15）%比（86.76±4.05）%］（均P<0.05）；观察组FEV₁、FVC、PEF、MVV均高于对照组［（1.99±0.30）L比（1.65±0.28）L、（2.99±0.33）L比（2.68±0.27）L、（6.54±0.76）L/s比（5.37±0.71）L/s、（47.83±5.45）L/min比（44.89±5.31）L/min］（均P<0.05）；观察组SF-36中的生理职能、躯体疼痛、情感职能、生命活力、心理健康、躯体功能、社会功能、总体健康评分均高于对照组（均P<0.05）。干预期间，观察组并发症总发生率低于对照组［5.13%（2/39）比23.08%（9/39）］（P<0.05）。观察组护理满意度中的服务及时性、工作能力、服务态度、健康教育指导、护理效果评分均高于对照组（均P<0.05）。结论　分阶段肺康复锻炼干预可改善成人ARDS患者血气指标、肺功能，减少并发症发生，提高生活质量和护理满意度。

关键词:

急性呼吸窘迫综合征, 分阶段肺康复锻炼, 血气指标, 肺功能, 并发症, 生活质量

Abstract:

Objective　To investigate the effect of staged pulmonary rehabilitation exercise in adult patients with acute respiratory distress syndrome (ARDS). Methods　A prospective study was conducted on 78 adult ARDS patients admitted to the Second Affiliated Hospital of Zhengzhou University from January 2022 to January 2024, and they were divided into a control group and an observation group by the random number table method. In the control group, there were 20 males and 19 females, aged 26-75 (50.59±3.78) years; the etiology was acute shock in 12 cases, sepsis in 7 cases, trauma in 9 cases, fat embolism in 6 cases, and severe pancreatitis in 5 cases; there were 13 mild cases, 15 moderate cases, and 11 severe cases. In the observation group, there were 21 males and 18 females, aged 25-74 (50.64±3.82) years; the etiology was acute shock in 13 cases, sepsis in 6 cases, trauma in 10 cases, fat embolism in 7 cases, and severe pancreatitis in 3 cases; there were 14 mild cases, 16 moderate cases, and 9 severe cases. The control group received routine nursing intervention, and the observation group received phased pulmonary rehabilitation exercise on the basis of routine nursing. Both groups continued the intervention until the patients were discharged. The nursing satisfaction (self-made nursing satisfaction questionnaire of the Second Affiliated Hospital of Zhengzhou University), blood gas indicators [partial pressure of carbon dioxide (PaCO₂), partial arterial pressure of oxygen (PaO₂), and oxygen saturation (SaO₂)], pulmonary function [forced expiratory volume in the first second (FEV₁), forced vital capacity (FVC), peak expiratory flow (PEF), and maximum volume per minute (MVV)], and quality of life [Health Survey Short Form (SF-36)] before and after intervention, occurrence of complications during intervention (ventilator associated pneumonia, pressure sores, delirium, muscle atrophy, etc.) were compared between the two groups. Independent sample t test, paired t test, and χ² test were used for statistical analysis. Results　After intervention, the PaCO₂ of the observation group was lower than that of the control group [(48.31±2.59) mmHg (1 mmHg= 0.133 kPa) vs. (53.26±2.77) mmHg], and the PaO₂ and SaO₂ were higher than those of the control group [(82.29±4.68) mmHg vs. (73.37±4.54) mmHg, (94.37±1.15)% vs. (86.76±4.05)%] (all P<0.05). The FEV₁, FVC, PEF, and MVV in the observation group were higher than those in the control group [(1.99±0.30) L vs. (1.65±0.28) L, (2.99±0.33) L vs. (2.68±0.27) L, (6.54±0.76) L/s vs. (5.37±0.71) L/s, (47.83±5.45) L/min vs. (44.89±5.31) L/min] (all P<0.05). The physiological function, physical pain, emotional function, vital vitality, mental health, physical function, social function, and overall health scores of the SF-36 in the observation group were higher than those in the control group (all P<0.05). During the intervention period, the total complication rate of the observation group was lower than that of the control group [5.13% (2/39) vs. 23.08% (9/39)] (P<0.05). The scores of service timeliness, working ability, service attitude, health education guidance, and nursing effect in the observation group were higher than those in the control group (all P<0.05). Conclusion　Phased pulmonary rehabilitation exercise can improve the blood gas indexes and lung function in adult ARDS patients, reduce the complications, and improve the patients' quality of life and nursing satisfaction.

Key words:

Acute respiratory distress syndrome, Phased pulmonary rehabilitation exercise, Blood gas indexes, Lung function, Complications, , Quality of life

李亚辉李彩蝶赵翔.

分阶段肺康复锻炼在成人急性呼吸窘迫综合征患者中的应用效果观察 [J]. 国际医药卫生导报, 2025, 31(1): 127-131.

Li Yahui, Li Caidie, Zhao Xiang.

Observation on the effect of staged pulmonary rehabilitation exercise in adult patients with acute respiratory distress syndrome [J]. International Medicine and Health Guidance News, 2025, 31(1): 127-131.

参考文献

[1] 刘婉琳,付敏,夏兰,等.改良俯卧位通气在成人急性呼吸窘迫综合征患者的应用[J].湖南中医药大学学报,2021,41(7):1120-1125.DOI:10.3969/j.issn.1674-070X.2021.07.026.
[2] 李克芳,孙潺,崔艳红,等.密闭式吸痰联合肺复张在急性呼吸窘迫综合征俯卧位机械通气患者的应用观察[J].护士进修杂志,2021,36(1):79-81.DOI:10.16821/j.cnki.hsjx.2021. 01.019.
[3] 冯月梅,孙乔,关纯,等.早期肺康复训练对ICU急性呼吸窘迫综合征有创机械通气患者脱机后预后的影响研究[J].中华危重病急救医学,2024,36(3):286-292.DOI:10.3760/cma.j.cn121430-20231009-00856.
[4] 江雅倩,陈钊,徐海燕,等.心脏手术后急性呼吸窘迫综合征患者俯卧位通气治疗效果及有效时长观察[J].护理学报,2023,30(9):60-64.DOI:10.16460/j.issn1008-9969.2023. 09.060.
[5] 葛均波,徐永健,王辰.内科学[M].9版.北京:人民卫生出版社,2018:130-134.
[6] 张振,谷雪峰.ESEIA理论下气道管理在重症颅脑损伤合并ARDS患者机械通气中的应用[J].国际医药卫生导报,2022,28(14):2039-2043.DOI:10.3760/cma.j.issn.1007-1245. 2022.14.026.
[7] 殷文超,刘莅欣.俯卧位机械通气在重症肺炎伴急性呼吸窘迫综合征患者中的疗效分析[J].中国临床医生杂志,2022,50(9):1054-1056.DOI:10.3969/j.issn.2095-8552.2022. 09.013.
[8] 孙瑞祥,江海娇,王箴,等.体外肋膈辅助技术在急性呼吸窘迫综合征患者机械通气中的应用[J].中国急救医学,2021,41(11):927-931.DOI:10.3969/j.issn.1002-1949.2021. 11.002.
[9] 陈天阳,诸炳骅,姜春雷,等.二术清解方联合纤维支气管镜肺泡灌洗治疗急性呼吸窘迫综合征机械通气的临床观察[J].中国中医急症,2023,32(7):1223-1226.DOI:10.3969/j.issn.1004-745X.2023.07.025.
[10] 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.DOI:10.3969/j.issn.1004-3594.2021.11.005.
[11] 宋淳,仲秀玲,李燕,等.俯卧位通气体位管理垫在重度急性呼吸窘迫综合征病人中的应用效果[J].护理研究,2023,37(10):1857-1860.DOI:10.12102/j.issn.1009-6493.2023. 10.032.
[12] 陈美珊,谢漫,方华茹,等.专科护士主导的肺复张模式在急性呼吸窘迫综合征患者康复中应用的有效性与可行性分析[J].现代临床护理,2023,22(12):17-23.DOI:10.3969/j.issn.1671-8283.2023.12.003.
[13] 楚春香,罗健玲,刘惠玲,等.动态变化俯卧位机械通气联合护理干预在急性呼吸窘迫综合征患者中的应用效果[J].国际医药卫生导报,2021,27(15):2384-2387.DOI:10.3760/cma.j.issn.1007-1245.2021.15.044.
[14] 赵玲,刘英,姜琦,等.1例中毒性表皮坏死松解症患者合并急性呼吸窘迫综合征的护理[J].中华护理杂志,2023,58(13):1629-1634.DOI:10.3761/j.issn.0254-1769.2023.13.015.
[15] 王春丹,穆记兰,刘丹,等.改良式俯仰交替卧位改善急性呼吸窘迫综合征机械通气患者肺功能临床效果评估[J].中国医学装备,2023,20(3):109-112.DOI:10.3969/J.ISSN.1672- 8270.2023.03.023.
[16] 柯向群,马金鹏,保成英.基于FMEA的精细化护理模式联合早期俯卧位通气在急性呼吸窘迫综合征患者中的应用及其对LBP、sTM和EVLWI的影响[J].中国急救复苏与灾害医学杂志,2022,17(4):512-516.DOI:10.3969/j.issn.1673- 6966.2022.04.022.
[17] 胡晓芳,韩燕,金瑞华.肠内营养耐受评估表用于ARDS俯卧位通气病人肠内营养支持的效果分析[J].护理研究,2022,36(12):2243-2246.DOI:10.12102/j.issn.1009-6493.2022. 12.035.
[18] 徐莹萤,邹洁,许红阳.密闭式吸痰结合恒速小量持续气道湿化对急性呼吸窘迫综合征的影响[J].国际医药卫生导报,2021,27(4):515-518.DOI:10.3760/cma.j.issn.1007-1245. 2021.04.010.
[19] 高春华,林燕,王辉,等.急性呼吸窘迫综合征合并锑中毒1例的护理[J].护理与康复,2021,20(10):53-56.DOI:10.3969/j.issn.1671-9875.2021.10.012.
[20] 徐大才,丁蓉,张磊,等.多部位俯卧位乳胶垫在重度急性呼吸窘迫综合征行俯卧位通气患者中的应用效果[J].中国实用护理杂志,2023,39(30):2329-2334.DOI:10.3760/cma.j.cn211501-20221027-03304.
[21] 齐艳丽,张黎.不同俯卧位联合反特伦德伦伯格卧位方案对ARDS患者肺通气功能及呼吸力学的影响[J].医学临床研究,2023,40(2):180-182,186.DOI:10.3969/j.issn.1671- 7171.2023.02.006.
[22] Burey J, Guitard PG, Girard N, et al. Impact of nursing care on lung functional residual capacity in acute respiratory distress syndrome patients[J]. Nurs Crit Care, 2022, 27(5):652-657. DOI: 10.1111/nicc.12630.
[23] 王家乐,胡琼燕,韦波,等.精细化腹内压管理对重症急性胰腺炎合并急性呼吸窘迫综合征患者呼吸功能的影响[J].广西医学,2023,45(16):1921-1927.DOI:10.11675/j.issn.0253-4304.2023.16.01.
[24] 蒋燕,陆叶,蒋旭琴,等.成人急性呼吸窘迫综合征患者俯卧位通气管理的最佳证据总结[J].中华护理杂志,2022,57(15):1878-1885.DOI:10.3761/j.issn.0254-1769.2022. 15.013.
[25] 宋莉莉,童萍,赵雪,等.床旁轮椅端坐活动对急性呼吸窘迫综合征机械通气患者EICU获得性肌无力的改善作用[J].中国实用护理杂志,2022,38(1):50-54.DOI:10.3760/cma.j.cn211501-20201207-04747.