早期下肢肌力训练在AECOPD无创通气患者中的疗效观察
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摘要
目的:观察慢性阻塞性肺疾病急性加重期(AECOPD)并Ⅱ型呼吸衰竭患者,进行无创通气联合下肢肌力训练的治疗效果、对心肺功能的影响。方法:选取我院呼吸与危重症医学科普通病房住院患者,共42例,随机分为早期下肢肌力训练组(早期组,22例)和对照组(20例),两组患者均给予无创机械通气和常规药物治疗,其中早期组在医护人员监测下进行早期下肢肌力训练。比较分析两组患者总住院时间、显效时间、心功能、膈肌功能、肺通气功能、改良版英国医学研究委员会呼吸困难问卷评分。结果:两组患者的住院时间、PaCO_2较入院时下降20%的天数、心率、左室射血分数、吸气末膈肌厚度、膈肌增厚分数、FEV_1、FEV_1/FEV_6%、血气分析、呼吸困难问卷评分均较入院时改善,差异有统计学意义(P<0.05);且早期组较对照组改善更明显,差异有统计学意义(P<0.05)。结论:对AECOPD并呼吸衰竭患者进行无创通气联合早期下肢肌力训练,有利于改善患者心肺功能,促进呼衰的恢复,缩短无创通气和住院时间,减少呼吸机依赖,提高患者生活质量。
Objective:To observe the effect of noninvasive positive pressure ventilation(NIPPV) combined with lower limb strength training and the effect on cardiopulmonary function in patients with acute exacerbation of chronic obstructive pulmonary disease(AECOPD) and type Ⅱ respiratory failure.Methods:A total of 42 patients in the general ward of the Department of Respiratory and Critical Care Medicine were randomly divided into the early lower extremity muscle training group(early group,22 cases) and the control group(20 cases).Non-invasive mechanical ventilation and conventional drug therapy,in which the early group underwent early lower limb strength training under the supervision of medical staff.The total hospitalization time,marked time,cardiac function, diaphragm function, pulmonary ventilation function,and dyspnea questionnaire scores were compared between the two groups.Results:Hospital stay,PaCO_2 decreased by 20% compared with admission,heart rate, left ventricular ejection fraction,inspiratory diaphragm thickness, diaphragm thickening fraction,FEV_1,FEV_1/FEV_6%,blood gas analysis, improved version the British Medical Research Council's dyspnea questionnaire was improved compared with the admission, the difference was statistically significant(P<0.05);and the early group was significantly improved compared with the control group,the difference was statistically significant(P<0.05).Conclusion:NIPPV combined with early lower limb strength training in patients with AECOPD and respiratory failure is beneficial to improve cardiopulmonary function,promote recovery of respiratory failure,shorten non-invasive ventilation and hospitalization time,reduce ventilator dependence,and improve patient quality of life.
Objective:To observe the effect of noninvasive positive pressure ventilation(NIPPV) combined with lower limb strength training and the effect on cardiopulmonary function in patients with acute exacerbation of chronic obstructive pulmonary disease(AECOPD) and type Ⅱ respiratory failure.Methods:A total of 42 patients in the general ward of the Department of Respiratory and Critical Care Medicine were randomly divided into the early lower extremity muscle training group(early group,22 cases) and the control group(20 cases).Non-invasive mechanical ventilation and conventional drug therapy,in which the early group underwent early lower limb strength training under the supervision of medical staff.The total hospitalization time,marked time,cardiac function, diaphragm function, pulmonary ventilation function,and dyspnea questionnaire scores were compared between the two groups.Results:Hospital stay,PaCO_2 decreased by 20% compared with admission,heart rate, left ventricular ejection fraction,inspiratory diaphragm thickness, diaphragm thickening fraction,FEV_1,FEV_1/FEV_6%,blood gas analysis, improved version the British Medical Research Council's dyspnea questionnaire was improved compared with the admission, the difference was statistically significant(P<0.05);and the early group was significantly improved compared with the control group,the difference was statistically significant(P<0.05).Conclusion:NIPPV combined with early lower limb strength training in patients with AECOPD and respiratory failure is beneficial to improve cardiopulmonary function,promote recovery of respiratory failure,shorten non-invasive ventilation and hospitalization time,reduce ventilator dependence,and improve patient quality of life.
引文
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[11] 徐东红,何雅琳,王惠芳.呼吸训练对脑卒中患者肺功能的影响[J].医学理论与实践,2018,31(15):2346-2348.
[12] 李杏良,马盼盼,任松森,等.肺康复对慢性阻塞性肺疾病合并重度呼吸衰竭治疗的促进作用[J].中国老年学杂志,2015,(7):1783-1785.
[13] Umbrello M,Formenti P,Longhi D,et al.Diaphragm ultrasound as indicator of respiratory effort in critically ill patients undergoing assisted mechanical ventilation:a pilot clinical study[J].Crit Care,2015,19(4):161-171.
[14] Cahalin LP,Braga M,et al.Efficacy of diaphragmatic breathing in persons with chronic obstructive pulmonary disease:a review of the literature[J].J Cardiopulm Rehabil,2002,22(1):7-21.
[15] Ambrosino N,Cigni P.Non invasive ventilation as an additional tool for exercise training[J].Multidiscip Respir Med,2015,10(1):14-20.
[2] 李登媛,周向东.无创通气联合不同时机雾化吸入治疗AECOPD合并Ⅱ型呼吸衰竭患者的疗效对比[J].现代医药卫生,2016,32(6):833-835.
[3] 林贻照,严汇.无创呼吸机联合吸入不同药物治疗COPD合并呼衰患者疗效及安全性分析[J].医学理论与实践,2019,32(1):42-43.
[4] Akashiba T,Ishikawa Y,Ishihara H,et al.The Japanese respiratory society noninvasive positive pressure ventilation (NPPV) guidelines (second revised edition)[J].Respir Investig,2017,55(1):83-92.
[5] Global Strategy for the Diagnosis,Management and Prevention of COPD[R].Global Initiative for Chronic Obstructive Lung Disease (GOLD),2018.http://www.goldcopd.org.
[6] 张海国,严志学,刘文辉,等.无创正压通气治疗重叠综合征并发肺性脑病[J].实用医学杂志,2017,33(8):1274-1276.
[7] Schepens T,Verbrugghe W,Dams K,et al.The course of diaphragm atrophy in ventilated patients assessed with ultrasound:a longitudinal cohort study[J].Crit Care,2015,19(1):422-430.
[8] Greening NJ,Williams JE,Hussain SF,et al.An early rehabilitation intervention to enhance recovery during hospital admission for an exacerbation of chronic respiratory disease:randomised controlled trial[J].BMJ,2014,349(8):g4315-4327.
[9] Wedzicha JA,Miravitlles M,Hurst JR,et al.Management of COPD exacerbations:a European Respiratory Society/American Thoracic Society guideline[J].Eur Respir J,2017,49(3):160091-160107.
[10] Ankj?rgaard KL,Maibom SL,Wilcke JT.Long-term non-invasive ventilation reduces readmissions in COPD patients with two or more episodes of acute hypercapnic respiratory failure[J].European clinical respiratory journal,2016,3(3):28303-28312.
[11] 徐东红,何雅琳,王惠芳.呼吸训练对脑卒中患者肺功能的影响[J].医学理论与实践,2018,31(15):2346-2348.
[12] 李杏良,马盼盼,任松森,等.肺康复对慢性阻塞性肺疾病合并重度呼吸衰竭治疗的促进作用[J].中国老年学杂志,2015,(7):1783-1785.
[13] Umbrello M,Formenti P,Longhi D,et al.Diaphragm ultrasound as indicator of respiratory effort in critically ill patients undergoing assisted mechanical ventilation:a pilot clinical study[J].Crit Care,2015,19(4):161-171.
[14] Cahalin LP,Braga M,et al.Efficacy of diaphragmatic breathing in persons with chronic obstructive pulmonary disease:a review of the literature[J].J Cardiopulm Rehabil,2002,22(1):7-21.
[15] Ambrosino N,Cigni P.Non invasive ventilation as an additional tool for exercise training[J].Multidiscip Respir Med,2015,10(1):14-20.