Observation on the effect of staged pulmonary rehabilitation exercise in adult patients with acute respiratory distress syndrome

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

Abstract

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

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

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.

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.

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