| Objective:To investigate the effect of early progressive exercise,chest physical therapy,diaphragm pacing therapy and other comprehensive lung rehabilitation measures on the respiratory function and inflammatory level in patients with severe pneumonia undergoing mechanical ventilation.Formulate the implementation process of early comprehensive lung rehabilitation,and provide basis for ICU patients with mechanical ventilation to implement effective early comprehensive lung rehabilitation program.Methods: This study adopts quasi-experimental research.From September 2018 to August 2019,73 patients who met the inclusion criteria were selected and divided into control group(37 cases)and experimental group(36cases)by computer random method.The control group received nursing according to the nursing routine for patients with mechanical ventilation in ICU ward,including anti-infection,nutritional support,basic nursing,mechanical sputum suction,routine exercise and other measures.On the basis of ICU nursing routine,On the basis of ICU nursing routine,the experimental group implemented early comprehensive lung rehabilitation nursing within 24-48 hours of mechanical ventilation,mainly including multidisciplinary consultation,overall evaluation,early progressive exercise,early chest lung physical therapy,diaphragmatic pacing therapy,psychological care and other measures.The early exercise mainly refers to passive and active,in-bed or out-of-bed activities according to the severity of the patient’s condition.The early chest lung physical therapy mainly includes respiratory training(diaphragmatic training,respiratory guidance,respiratory control)and airway clearance therapy(chest tapping,postural drainage,manual vibration sputum excretion),etc.;The overall time of intervention is from the time when the patient’s condition is stable(within 24-48hours)to the time when the patient leaves the ventilator.The follow-up time points of respiratory physiology and inflammation indexes were the 1st,4rd and7 th days of intervention.The general data,vital signs,blood gas physiological indexes(Pa O2,Pa CO2,OI,Lac),inflammatory indexes(leukocyte,CRP,PCT),offline possibility prediction index(RSBI),blood routine,CT or X-ray,limb B-ultrasound results and other data were collected within 24 hours after all patients were admitted to ICU ward.Blood routine,incidence rate of mechanical ventilation complications(atelectasis,thrombosis,etc.),mechanical ventilation time and ICU stay time were collected again before the two groups of patients were transferred to ICU ward(within 24 hours).Respiratory physiological indexes(Pa O2,Pa CO2,OI,Lac),weaning effect prediction indexes(RSBI)and inflammatory indexes(leukocyte,CRP,PCT)were recorded on the 1st,4rd and7 th days during the intervention.SPSS22.0 statistical software was used for statistical analysis of the collected data.Chi-square test was used for counting data(male/female ratio,disease diagnosis type,proportion of pulmonary diseases,etc.),T test and variance test were used for measuring data(Pa O2,Pa CO2,OI,Lac,etc.),repeated measurement variance analysis was used for comparison of observation indexes at different time points,and the test levelα=0.05.Results:1.Comparison of basic information and clinical data between the two groups: there was no statistical difference between the two groups in general data such as age,sex,intubation method,APACHE-Ⅱ score within 24 hours,disease diagnosis type and so on(P>0.05),which was comparable.2.Comparison of main observation indexes between the two groups of patients:(1)within 24 hours after admission to ICU,there was no statistical difference between the respiratory physiological indexes(Pa O2,Pa CO2,OI,Lac)and inflammatory indexes(white blood cells,CRP,PCT)of the two groups of patients(P>0.05),which was comparable.(2)after early comprehensive lung rehabilitation intervention,there was no statistical difference between the two groups in respiratory physiological indexes,inflammatory indexes,predicted weaning indexes and other data on the 1st and 4th day of intervention(P>0.05);(3)on the 7th day of intervention,Pa O2 and OI values in the experimental group were significantly higher than those in the control group,and the difference was statistically significant(P<0.05).The values of Pa CO2,OI,Lac,WBC,CRP,PCT and RSBI in the experimental group were significantly lower than those in the control group,with statistically significant difference(P<0.05).(4)there was statistical difference between the repeated measurement results of respiratory physiological indexes,inflammatory indexes and weaning effect prediction indexes at different time points between the two groups(P<0.05).3.Comparison of the incidence rate of mechanical ventilation complications between the two groups: when the two groups of patients were transferred out of ICU,the incidence rate of VAP between the control group and the test group was 6:3,the incidence rate of lower limb thrombosis was 3:1,and the incidence rate of atelectasis was 9:2.there was no statistical difference among the three(P>0.05).4.Comparison of mechanical ventilation and ICU stay time between the two groups: the mechanical ventilation time(10.75±4.43)days and ICU stay time(14.0±5.36)days of the patients in the experimental group are less than those in the control group(13.30±5.75)days and(16.55±5.58)days,with no significant difference(P>0.05).5.Safety and feasibility of early comprehensive lung rehabilitation:(1)safety.In the experimental group,2 patients had transient heart rate and respiratory acceleration(<10% of the original value)during chest wall tapping,1 patient had blood pressure drop(<10% of the original value)during postural drainage,and 2 patients had blood pressure increase(only>10% of the original value)during early staged activities.Two patients in the control group showed fluctuations in vital signs during back tapping,but all of them were less than10% of the original value.The vital signs of 7 patients returned to normal after suspension of intervention and rest.(2)case death or lost follow-up: in the follow-up visit,4 patients in the control group and 2 patients in the test group died due to disease changes.After strict evaluation before intervention,there were no other serious complications or pipeline shedding in the two groups of patients during the study period.During the study,one patient in the test group who could not tolerate early lung rehabilitation chose to quit during the follow-up study.Conclusion:1.Early comprehensive lung rehabilitation can effectively improve respiratory function and inflammation level of mechanically ventilated patients,and enhance the possibility of successful weaning for the first time,indicating that early limb rehabilitation is as important as respiratory rehabilitation.2.Early pulmonary rehabilitation team based on rehabilitation therapist,ICU doctors and nurses is safe,feasible and effective to implement early progressive activities and early respiratory rehabilitation for patients with mechanical ventilation. |
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