早期活动对慢性阻塞性肺疾病急性加重机械通气患者谵妄及呼吸力学影响的前瞻性研究

发布时间：2018-03-24 13:32

本文选题：慢性阻塞性肺疾病急性加重　切入点：机械通气　出处：《中国呼吸与危重监护杂志》2016年04期

【摘要】：目的探讨慢性阻塞性肺疾病(简称慢阻肺)急性加重机械通气患者的谵妄发生情况以及早期活动对其呼吸力学、谵妄及预后的影响。方法纳入2014年1月至2015年6月单县中心医院收治的107例血流动力学稳定、接受机械通气治疗的慢阻肺急性加重患者,随机分为治疗组54例和对照组53例。在相同常规治疗基础上,治疗组予以进行早期活动,对照组予以常规镇静镇痛。观察两组患者谵妄的发生率、谵妄持续时间、机械通气时间、ICU病死率的差异,两组患者治疗前以及治疗后3 d和5 d呼吸力学参数[内源性呼气末正压(PEEPi)、气道阻力(Raw)、静态顺应性(Cs)、动态顺应性(Cd)]的差异。结果治疗组谵妄发生率较对照组患者下降(59.3%比77.4%),谵妄持续时间缩短[(1.8±1.1)d比(2.6±1.3)d],机械通气时间减少[(6.2±3.4)d比(7.9±4.2)d],差异有统计学意义(P0.05)。两组患者治疗前各项呼吸力学参数差异均无统计学意义(P0.05),组间有可比性。治疗组与对照组比较,PEEPi治疗后3 d[(6.23±2.83)cm H_2O比(7.42±2.62)cm H_2O]、5 d[(4.46±2.20)cm H_2O比(5.92±2.51)cm H_2O]均下降;Raw治疗后3 d[(20.35±7.15)cm H_2O·L-1·s-1比(23.23±6.64)cm H_2O·L-1·s-1]、5 d[(16.00±5.41)cm H_2O·L-1·s-1比(19.02±6.37)cm H_2O·L-1·s-1]均缩小;Cd治疗后3 d[(25.20±9.37)m L/cm H_2O比(21.75±7.38)m L/cm H_2O]、5 d[(27.46±5.45)m L/cm H_2O比(24.40±6.68)m L/cm H_2O]均增大,差异有统计学意义(P0.05);两组治疗后3 d和5 d时的Cs差异无统计学意义(P0.05)。两组患者均未发生管道滑脱、肢体损伤、恶性心律失常等并发症。治疗组较对照组患者病死率下降(5.6%比11.3%),但差异无统计学意义(P0.05)。结论慢阻肺急性加重机械通气患者谵妄的发生率高。早期活动能够减少其谵妄的发生率和持续时间,能够降低其气道阻力,增加肺Cd,改善动态肺过度充气状态,降低PEEPi,改善呼吸功能,缩短机械通气时间,安全有效,值得临床推广。
[Abstract]:Objective to investigate the incidence of delirium in patients with acute exacerbation mechanical ventilation of chronic obstructive pulmonary disease (COPD) and the effect of early activity on respiratory mechanics. Methods from January 2014 to June 2015, 107 patients with acute exacerbation of COPD treated by mechanical ventilation were enrolled in 107 patients with stable hemodynamics and mechanical ventilation, who were admitted to Shanxian Central Hospital from January 2014 to June 2015. 54 cases in the treatment group and 53 cases in the control group were randomly divided into two groups. On the basis of the same routine treatment, the treatment group was given early activities, and the control group was given routine sedation and analgesia. The incidence of delirium and the duration of delirium in the two groups were observed. The time of mechanical ventilation and the mortality of ICU. The difference of respiratory mechanical parameters between the two groups before treatment, 3 days and 5 days after treatment [endogenous positive end-expiratory pressure pee Pig, airway resistance, static compliance with CSI, dynamic compliance with CD]. Results the incidence of delirium in the treatment group was higher than that in the control group. The duration of delirium was decreased by 59.3% to 77.4%, the duration of delirium was shortened [1.8 卤1.1 days vs 2.6 卤1.3 days], the time of mechanical ventilation was decreased [6.2 卤3.4 days vs 7.9 卤4.2 days], the difference was statistically significant (P 0.05). Compared with the control group, the number of PEEPi groups decreased 3 days after treatment [6.23 卤2.83)cm H2O vs 7.42 卤2.62)cm H2O] 5 days [4.46 卤2.20)cm H2O vs 5.92 卤2.51)cm H2O] decreased 3 days after Raw treatment [20.35 卤7.15)cm H2O L-1 s-1 vs 23.23 卤6.64)cm H2O L-1 s-1] 5 days [16.00 卤5.41)cm H20 卤6.37)cm H2O L-1 vs 19.02 卤6.37)cm H2O L-1 s-1] all increased 3 days after treatment [25.20 卤9.37 m L/cm H2O / 21.75 卤7.38 m L/cm H2O] 5 days [27.46 卤5.45 m L/cm H 2O vs 40 卤6.68 m L/cm H 2O]. There was no significant difference in Cs between the two groups at 3 and 5 days after treatment. The mortality of patients in the treatment group decreased by 5.6% compared with that of the control group, but the difference was not statistically significant (P 0.05). Conclusion the incidence of delirium in patients with acute exacerbation of chronic obstructive pulmonary disease is higher than that in the control group. Early exercise can reduce the incidence of delirium. The incidence and duration of delirium, It can reduce airway resistance, increase lung CD, improve dynamic lung hyperinflation, reduce PEEPi, improve respiratory function, shorten mechanical ventilation time, and is safe and effective. It is worth popularizing in clinic.
【作者单位】：济宁医学院附属湖西医院(单县中心医院)呼吸内科;济宁医学院附属湖西医院(单县中心医院)ICU;山东大学附属省立医院呼吸内科;
【基金】：国家自然科学基金(编号:81370138) 山东省医药卫生科技发展计划项目(编号:2015WS0467)
【分类号】：R563.9

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