The Effect Of Early Pulmonary Rehabilitation In Patients With Acute Exacerbation Of Chronic Obstructive Pulmonary Disease During Non-invasive Mechanical Ventilation

Objective:The purpose of this study was to observe the feasibility and safety of early pulmonary rehabilitation in patients with acute exacerbation of chronic obstructive pulmonary disease during non-invasive mechanical ventilation,whether it can reduce carbon dioxide retention,improve respiratory function,alleviate dyspnea,shorten ICU hospitalization time,improve sports endurance,quality of life and activities of daily living,and evaluate its effect.Materials and methods:A total of 38 patients with acute exacerbation of chronic obstructive pulmonary disease who were hospitalized in the emergency intensive care ward of China-Japan Union Hospital of Jilin University from July 2019 to December 2020 were randomly divided into two groups:rehabilitation group（n=20）and control group（n=18）.The control group was given routine treatment and routine nursing methods,including vital sign monitoring,non-invasive mechanical ventilation,anti-infection,expectorant,anti-infection and other drug treatments,routine turn over and back slapping（once every 2 hours）.And sputum suction,mechanical expectoration and so on.On the basis of the control group,the rehabilitation group began related pulmonary rehabilitation training within 48 hours of admission until discharge,mainly including sports function training,respiratory function training,related nutritional support,and targeted psychological support and health education.After admission and 7 days after pulmonary rehabilitation intervention,patients in both groups were tested with 30-second Sit-to-Stand Test（30s STST）,Modified British Medical Research Council（m MRC）,Modified Barthel Index Rating Scale（MBI）,Chronic Obstructive Pulmonary Disease Assessment Test（CAT）,partial pressure of carbon dioxide（Pa CO₂）and partial pressure of oxygen（Pa O₂）.The ICU hospitalization time of all patients and the incidence of adverse events in rehabilitation group was recorded.Through the statistical analysis of the above 8 indexes,to evaluate the safety and feasibility of early pulmonary rehabilitation in this kind of patients and to evaluate its effect.Results:1.After 7 days of pulmonary rehabilitation intervention,compared with the control group,the arterial blood Pa CO₂ of the rehabilitation group decreased more significantly（rehabilitation group:40.4±3.6mm Hg,control group 43.7±3.0mm Hg）,P<0.05,which was statistically significant;2.After 7 days of pulmonary rehabilitation intervention,compared with the control group,the increase of arterial Pa O₂ in the rehabilitation group was more obvious（rehabilitation group:71.8±3.9 mm Hg,control group 69.4±2.7 mm Hg）,P<0.05,which was statistically significant;3.After 7 days of pulmonary rehabilitation intervention,compared with the control group,The m MRC score of the rehabilitation group decreased more significantly（rehabilitation group:2.00±0.65 scores,control group:2.67±0.69 scores）,P<0.05,which was statistically significant;4.After 7 days of pulmonary rehabilitation intervention,compared with the control group,the number of 30-second Sit-to-Stand Test（30s STST）of the rehabilitation group increased more significantly（rehabilitation group:10.85±2.03 times,control group:9.44±1.92 times）,P<0.05,which was statistically significant;5.After 7 days of pulmonary rehabilitation intervention,compared with the control group,the CAT score of the rehabilitation group decreased more significantly（rehabilitation group:14.45±2.0 scores,control group:16.06±2.39 scores）,P<0.05,which was statistically significant;6.After 7 days of pulmonary rehabilitation intervention,compared with the control group,The MBI score of the rehabilitation group increased more significantly（rehabilitation group:45.35±7.78 scores,control group:38.83±7.88 scores）,P<0.05,which was statistically significant;7.After the intervention of pulmonary rehabilitation therapy,there was no significant difference in the length of ICU hospitalization between the two groups;8.No adverse events occurred in all patients in the rehabilitation group.Conclusion:1.Early pulmonary rehabilitation therapy can reduce carbon dioxide retention and improve pulmonary ventilation function in AECOPD patients with non-invasive mechanical ventilation.2.Early pulmonary rehabilitation can reduce the degree of dyspnea,improve exercise endurance,and improve the quality of life and ability of daily life in AECOPD patients with non-invasive mechanical ventilation.3.It is feasible and safe for AECOPD patients with non-invasive mechanical ventilation to receive early lung rehabilitation within 48 hours after admission,and there are no adverse events.