Application of individualized comprehensive early pulmonary rehabilitation in elderly patients requiring mechanical ventilation for severe community-acquired pneumonia (个性化早期综合肺康复护理在老年重症社区获得性肺炎机械通气患者中的应用)

Abstract

Objective To investigate the effect of individualized comprehensive early pulmonary rehabilitation in elderly patients requiring mechanical ventilation for severe community-acquired pneumonia (SCAP). Methods Totally 100 elderly patients requiring mechanical ventilation for SCAP were randomly divided into the control group and study group, with 50 cases in each group. Patients of the control group received routine comprehensive nursing during treatment, and those in the study group were given individualized comprehensive early pulmonary rehabilitation based on the routine care. The respiratory physiological indexes ( oxygenation index, lactic acid, rapid-shallow-breathing index), inflammation-related indicators, duration of ventilatory support, first-time success rate of ventilator extubation, length of ICU stay, incidence of complications of mechanical ventilation(pulmonary atelectasis and limb thrombus) were compared between two groups. Results The oxygenation index in the study group was higher than that in the control group(P＜0. 05). Patients in the study group had lower rapid-shallow-breathing index, lactic acid level, white blood cell count, procalcitonin level and C-reactive protein level compared with those in the control group(P＜0. 05). The first-time success rate of ventilator extubation in the study group was lower than that in the control group(P＜0. 05). Patients in the study group had a shorter duration of ventilatory support, shorter length of ICU stay and lower incidences of pulmonary atelectasis and limb thrombus compared with those in the control group(P＜0. 05). Conclusion The individualized comprehensive early pulmonary rehabilitation is effective to improve the pulmonary function of oxygenation, reduce the risk of complications of mechanical ventilation and improve the recovery of elderly patients requiring mechanical ventilation for SCAP. (目的 探索个性化早期综合肺康复护理在老年重症社区获得性肺炎(SCAP)行机械通气治疗患者中的应用效果。方法 选取医院收治100例老年重症社区获得性肺炎行机械通气患者为研究对象, 随机分为对照组50例和试验组50例。对照组实施常规综合护理干预, 试验组在对照组基础上实施个性化早期综合肺康复护理。比较两组干预后的呼吸生理指标(肺氧合功能、乳酸、浅快呼吸指数)、炎症相关指标、机械通气时间、首次脱机成功率、ICU治疗时间、机械通气并发症(肺不张发生率、肢体血栓发生率)。结果 干预后, 试验组氧合指数值高于对照组(P＜0. 05), 浅快呼吸指数、血清乳酸值、白细胞计数、降钙素原、C反应蛋白水平低于对照组(P＜0. 05)。试验组的首次脱机成功率高于对照组(P＜0. 05), 机械通气时间、ICU治疗时间、肺不张发生率、肢体血栓发生率及并发症总发生率低于对照组(P＜0. 05)。结论 个性化早期肺综合康复护理能够有效改善老年SCAP机械通气患者的肺氧合功能, 减轻炎症反应, 降低并发症发生率, 促进患者康复。)

Keywords

• severe community-acquired pneumonia
• elderly
• mechanical ventilation
• pulmonary rehabilitation
• individualized nursing
• 重症社区获得性肺炎
• 老年
• 机械通气
• 肺康复
• 个性化护理