陈琼　周朝阳　席明霞　成晶　屈婧

[关键词] 重症监护室;机械通气;多学科协作;肺康复

[中图分类号] R473.5          [文献标识码] B          [文章编号] 1673-9701（2021）17-0155-04

Effect of multidisciplinary collaborative intervention on pulmonary rehabilitation of patients with mechanical ventilation in ICU

CHEN Qiong   ZHOU Chaoyang   XI Mingxia    CHENG Jing    QU Jing

Department of Intensive Medicine， Changsha Central Hospital Affiliated to University of South China， Changsha 410004， China

[Abstract] Objective To explore the application effect of multidisciplinary cooperative intervention in lung rehabilitation of patients with mechanical ventilation in ICU. Methods A total of 88 patients with mechanical ventilation admitted to ICU from August 2019 to June 2020 were conveniently selected as the research objects.The control group received conventional rehabilitation intervention， while the intervention group was given multi-disciplinary cooperative intervention for lung rehabilitation. The mechanical ventilation time， weaning success rate， lung function and complications of the two groups of patients after intervention were compared. Results The mechanical ventilation time was significantly lower in the intervention group than that in the control group， and the weaning success rate was higher than that in the control group（P<0.05）. Forced vital capacity and forced expiratory volume in one second（FEV1） were significantly higher in the intervention group than those in the control group（P<0.05）. Complications such as ventilator-associated pneumonia， delirium and ICU acquired weakness were lower in the intervention group than those in the control group （P<0.05）. Conclusion Multidisciplinary cooperative intervention in lung rehabilitation can effectively shorten the time of mechanical ventilation， improve the success rate of weaning， improve lung function and reduce the incidence of complications of ICU patients with mechanical ventilation， which is worthy of clinical application.

[Key words] Intensive care unit; Mechanical ventilation; Multidisciplinary collaboration; Lung rehabilitation

隨着危重医学的快速发展，机械通气已成为ICU常规的治疗方法，其可以维持气道通畅、改善气体交换功能，为治疗各种基础疾病创造条件[1]。然而，机械通气的使用在提高重症患者治愈率的同时，也会带来一系列并发症，如呼吸机相关性肺炎、谵妄、获得性肌无力等，这些不良后果将直接影响患者机械通气时间及是否能成功脱机，不利于患者治疗效果和预后[2-3]。肺康复是一项以证据为基础的、多学科的综合干预方法，通过开展积极的呼吸肌训练和一般运动训练，提高呼吸肌肉和周围肌肉力量，维持理想的肺功能状态，改善患者预后[4-5]。但是，目前临床上针对重症患者仍没有普及肺康复，也缺乏科学有效的方法指导患者进行肺康复训练。多学科协作通过整合各学科专业技术的优点，为患者制订专业化、个体化、科学化的系统干预方案[6]。鉴于此，本研究旨在探讨多学科协作干预在ICU机械通气患者早期肺康复中的应用效果，为机械通气患者开展肺康复提供参考，现报道如下。

1 资料与方法

1.1 一般资料

选取本院ICU 2019年8月至2020年6月收治的机械通气患者88例。纳入标准：符合相关疾病诊断标准;年龄>18岁;已实施并预计实施机械通气时间≥72 h[7];意识清楚，具有行为实施能力;血流动力学稳定。排除标准：认知障碍不能沟通者;运动障碍者;神经系统疾病及严重器质性疾病者。按……