基于时机理论的多学科合作肺康复方案对重症肺炎机械通气患者的疗效观察

王世强; 刘文兵; 张玉娜; 袁凤; 金鑫来

doi:10.16766/j.cnki.issn.1674-4152.004223

基于时机理论的多学科合作肺康复方案对重症肺炎机械通气患者的疗效观察

doi: 10.16766/j.cnki.issn.1674-4152.004223

1.
浙江中医药大学附属杭州市中医院呼吸与危重症医学科，浙江杭州 310007
2.
浙江中医药大学附属第三医院康复医学科，浙江杭州 310005

基金项目:

浙江省医药卫生科技计划项目 2024KY1391

详细信息

通讯作者:
王世强，E-mail：qihuang_zhishu@163.com

中图分类号: R563.1 R49
计量
- 文章访问数: 1
- HTML全文浏览量: 0
- PDF下载量: 0
- 被引次数: 0
出版历程
- 收稿日期: 2025-03-04

Effects of transcranial direct current stimulation on therapeutic effect and cognitive function in patients with depression

1.
Department of Respiratory Medicine, Hangzhou Hospital of Traditional Chinese Medicine, Zhejiang Chinese Medicine University, Hangzhou, Zhejiang 310007, China

摘要

摘要: 目的探讨基于时机理论的多学科肺康复方案对重症肺炎机械通气患者的治疗效果，为重症肺炎机械通气患者的肺康复治疗提供依据。方法选取2024年3—12月杭州市中医院呼吸重症监护室和浙江中医药大学附属第三医院收治的60例重症肺炎患者，使用随机数字表法分为对照组(实施常规护理)及治疗组(实施基于时机理论的多学科肺康复方案)，每组各30例。比较2组患者疗效指标[ICU入住时间、机械通气时长、急性生理与慢性健康(APACHE-Ⅱ)评分]，血气指标[动脉血二氧化碳分压(PaCO₂)、动脉血氧分压(PaO₂)、血氧饱和度(SaO₂)、氧合指数]，生活质量及不良事件发生情况。结果干预后，治疗组ICU入住时间[(7.48±1.37)d vs. (9.65±1.45)d]、机械通气时长[(6.26±1.08)d vs. (8.41±1.61)d]及APACHE-Ⅱ评分[(9.14±1.75)分vs. (12.71±2.54)分]均小于对照组(P＜0.001)；治疗组PaCO₂[(29.35±4.53)mmHg vs. (37.18±4.92)mmHg，1 mmHg=0.133 kPa]、PaO₂[(84.69±7.45)mmHg vs. (77.84±7.19)mmHg]、氧和指数[(405.94±40.58)mmHg vs. (319.02±34.72)mmHg]等血气指标均优于对照组(P＜0.05)。治疗组生活质量各项评分均高于对照组(P＜0.05)。2组患者治疗期间均无明显不良事件发生。结论基于时机理论的多学科肺康复方案安全有效，可为重症肺炎机械通气患者肺康复提供新策略。
- 重症肺炎 /
- 时机理论 /
- 多学科合作 /
- 肺康复方案 /
- 机械通气
Abstract: Objective To investigate the effect of a multidisciplinary pulmonary rehabilitation program based on the timing theory on mechanically ventilated patients with severe pneumonia. The ultimate goal is to provide a basis for the pulmonary rehabilitation treatment of patients with severe pneumonia undergoing mechanical ventilation. Methods A total of 60 patients diagnosed with severe pneumonia were selected for this study. The patients were admitted to the Respiratory Intensive Care Unit of Hangzhou Hospital of Traditional Chinese Medicine and the Third Affiliated Hospital of Zhejiang Chinese Medical University from March to December 2024. The patients were divided into two groups: the control group and the treatment group. The random number table method was used to assign patients to each group. Each group contained 30 patients. The control group received routine nursing. The treatment group received a multidisciplinary pulmonary rehabilitation program based on timing theory. The efficacy indexes—which include the length of ICU stay, duration of mechanical ventilation, and acute physiology and chronic health (APACHE-Ⅱ) score, as well as the blood gas indexes [arterial partial pressure of carbon dioxide (PaCO₂), arterial partial pressure of oxygen (PaO₂), blood oxygen saturation (SaO₂), oxygenation index], quality of life and adverse events were compared between the two groups. Results Following the intervention, the treatment group exhibited a significant reduction in the duration of ICU stay [(7.48±1.37) d vs. (9.65±1.45) d], the duration of mechanical ventilation [(6.26±1.08) d vs. (8.41±1.61) d], and the APACHE-Ⅱ score [(9.14±1.75) points vs. (12.71±2.54) scores] were lower than those in the control group (P < 0.001). The PaCO₂ in the treatment group [(29.35±4.53) mmHg vs. (37.18±4.92) mmHg, 1 mmHg=0.133 kPa], PaO₂ [(84.69±7.45) mmHg vs. (77.84±7.19) mmHg], oxygenation index [(405.94±40.58) mmHg vs. (319.02±34.72) mmHg] were better than those in the control group (P < 0.05). The scores of quality of life in the treatment group were higher than those in the control group (P < 0.05). No obvious adverse events occurred in the two groups during treatment. Conclusion The multidisciplinary pulmonary rehabilitation program based on the timing theory is safe and effective, offering a new strategy for pulmonary rehabilitation in mechanically ventilated patients with severe pneumonia.
- Severe pneumonia /
- Timing theory /
- Multidisciplinary cooperation /
- Pulmonary rehabilitation program /
- Mechanical ventilation
利益冲突 无

HTML全文

表 1 2组重症肺炎患者疗效指标比较(x±s)

Table 1. Comparison of therapeutic effect indicators between two groups of patients with severe pneumonia(x±s)

组别	例数	ICU入住时间(d)	机械通气时长(d)	APACHE-Ⅱ评分(分)
对照组	30	9.65±1.45	8.41±1.61	12.71±2.54
治疗组	30	7.48±1.37	6.26±1.08	9.14±1.75
t值		5.958	6.074	6.339
P值		< 0.001	< 0.001	< 0.001

下载: 导出CSV

表 2 2组重症肺炎患者干预前后血气指标比较(x±s)

Table 2. Comparison of blood gas parameters between the two groups of patients with severe pneumonia, pre- and post-intervention(x±s)

组别	例数	PaCO₂(mmHg)		PaO₂(mmHg)		SaO₂(%)		氧合指数(mmHg)
组别	例数	干预前	干预后	干预前	干预后	干预前	干预后	干预前	干预后
对照组	30	46.81±6.74	37.18±4.92^b	50.25±6.22	77.84±7.19^b	85.39±6.01	89.14±4.63^b	162.79±17.53	319.02±34.72^b
治疗组	30	46.77±6.79	29.35±4.53^b	50.38±6.03	84.69±7.45^b	85.61±5.94	93.75±5.15^b	160.13±17.51	405.94±40.58^b
统计量		0.023^a	152.267^c	0.082^a	310.865^c	0.143^a	91.358^c	0.588^a	2 031.264^c
P值		0.982	< 0.001	0.935	< 0.001	0.887	< 0.001	0.559	< 0.001
注：^a为t值，^c为F值；与同组干预前比较，^bP＜0.05；1 mmHg=0.133 kPa。

下载: 导出CSV

表 3 2组重症肺炎患者治疗前后生活质量评分比较(x±s, 分)

Table 3. Comparison of life quality scores between the two groups of patients with severe pneumonia, pre- and post-intervention(x±s, points)

组别	例数	生理功能		心理功能		情感功能		社会功能
组别	例数	干预前	干预后	干预前	干预后	干预前	干预后	干预前	干预后
对照组	30	60.78±8.43	71.63±10.21^b	56.73±9.69	72.33±10.34^b	53.37±6.54	71.24±11.43^b	58.67±7.93	74.87±9.87^b
治疗组	30	60.34±8.36	84.96±11.65^b	57.39±9.38	84.67±11.38^b	52.93±7.25	85.11±12.53^b	58.36±7.67	84.13±10.59^b
统计量		0.203^a	162.342^c	0.268^a	201.374^c	0.247^a	428.537^c	0.154^a	372.109^c
P值		0.840	< 0.001	0.790	< 0.001	0.806	< 0.001	0.878	< 0.001
注：^a为t值，^c为F值；与同组干预前比较，^bP＜0.05。

下载: 导出CSV

参考文献(20)

[1]	LI B B, LI Z H, CHENG W, et al. Application of sputum suction by fiberoptic bronchoscope in patients with severe pneumonia and its effect on inflammatory factors[J]. Am J Transl Res, 2021, 13(7): 8409-8414.
[2]	PAPAZIAN L, KLOMPAS M, LUYT C E. Ventilator-associated pneumonia in adults: a narrative review[J]. Intensive Care Med, 2020, 46(5): 888-906. doi: 10.1007/s00134-020-05980-0
[3]	徐芳芳, 吴霞云, 王亚萍, 等. 多频震荡排痰机在重症肺炎患者的护理研究[J]. 中华全科医学, 2021, 19(2): 324-327. doi: 10.16766/j.cnki.issn.1674-4152.001800 XU F F, WU X Y, WANG Y P, et al. Study on Nursing Care of Patients with Severe Pneumonia with Multi-frequency Vibrating Sputum Extracto[J]. Chinese Journal of General Practice, 2021, 19(2): 324-327. doi: 10.16766/j.cnki.issn.1674-4152.001800
[4]	GROTBERG J C, REYNOLDS D, KRAFF B D. Management of severe acute respiratory distress syndrome: a primer[J]. Crit Care, 2023, 27(1): 289. DOI: 10.1186/s13054-023-04572-w.
[5]	HE Y X, LV Y, LAN T T, et al. Timing theory integrated nursing combined behavior change integrated theory of nursing on primiparous influence[J]. World J Clin Cases, 2024, 12(2): 293-301. doi: 10.12998/wjcc.v12.i2.293
[6]	陈新霞, 周苏明, 董奇芳, 等. 以时机理论为中心的延续性护理模式在抑郁症患者中的应用效果[J]. 中华全科医学, 2023, 21(11): 1977-1981. doi: 10.16766/j.cnki.issn.1674-4152.003271 CHEN X X, ZHOU S M, DONG Q F, et al. Application effect of a continuous nursing care centered on timing theory in patients with depression[J]. Chinese Journal of General Practice, 2023, 21(11): 1977-1981. doi: 10.16766/j.cnki.issn.1674-4152.003271
[7]	江波, 张军, 曹咪. 国内外老年居家照护的研究进展[J]. 护理学杂志, 2022, 37(4): 95-98. JIANG B, ZHANG J, CAO M. Research progress on home care for the elderly at home and abroad[J]. Journal of Nursing Science, 2022, 37(4): 95-98.
[8]	中国医师协会急诊医师分会. 中国急诊重症肺炎临床实践专家共识[J]. 中国急救医学, 2016, 36(2): 97-107. Chinese College of Emergency Physicians. Chinese expert consensus on clinical practice of severe pneumonia in emergency[J]. Chinese Journal of Critical Care Medicine, 2016, 36(2): 97-107.
[9]	ZI W J, QIU Z M, LI F L, et al. Effect of Endovascular treatment alone vs intravenous alteplase plus endovascular treatment on functional independence in patients with acute ischemic stroke: the DEVT randomized clinical trial[J]. JAMA, 2021, 325(3): 234-243. doi: 10.1001/jama.2020.23523
[10]	邹姮婧. 中文版CAM-ICU的信度效度检验及与其他量表的比较[D]. 武汉: 华中科技大学, 2012. ZHOU H J. Validity and reliability of CAM-ICU Chinese version and acomparison with other instruments[D]. Wuhan: Huazhong University of Science and Technology, 2012.
[11]	SMITH M J, HAYWARD S A, INNES S M, et al. Point-of-care lung ultrasound in patients with COVID-19: a narrative review[J]. Anaesthesia, 2020, 75(8): 1096-1104. doi: 10.1111/anae.15082
[12]	ZHANG S P, ZHU Q G, ZHAN C, et al. Acupressure therapy and LIU ZI JUE QIGONG for pulmonary function and quality of life in patients with severe novel coronavirus pneumonia (COVID-19): a study protocol for a randomized controlled trial[J]. Trials, 2020, 21(1): 751. DOI: 10.1186/s13063-020-04693-5.
[13]	陈惠川, 钟晓芳. 早期康复训练用于ICU重症肺炎机械通气患者的效果观察[J]. 中国现代药物应用, 2022, 16(23): 160-163. CHEN H C, ZHONG X F. Effect observation of early rehabilitation training on mechanically ventilated patients with severe pneumonia in ICU[J]. Chinese Journal of Modern Drug Application, 2022, 16(23): 160-163.
[14]	吴南平, 黄少武, 周燕妮, 等. 早期康复治疗对老年重症肺炎机械通气患者脱机情况及康复进程的影响[J]. 当代医学, 2022, 28(6): 148-150. WU N P, HUANG S W, ZHOU Y N, et al. Effect of early rehabilitation therapy on weaning status and rehabilitation process of elderly patients with severe pneumonia undergoing mechanical ventilation[J]. Contemporary Medicine, 2022, 28(6): 148-150.
[15]	陈美玲, 梁宝卿, 卢焕平. 基于"时机理论"的肺康复训练及护理对支气管哮喘的疗效观察[J]. 齐齐哈尔医学院学报, 2020, 41(8): 1038-1040. CHEN M L, LIANG B Q, LU H P. Observation on therapeutic effect of pulmonary rehabilitation training and nursing on bronchial asthma based on the"timing theory"[J]. Journal of Qiqihar Medical University, 2020, 41(8): 1038-1040.
[16]	梁进丽, 徐二喜, 李冬芬, 等. ICU过渡期多学科协作心肺康复在重症肺炎患者中的应用效果[J]. 广东医科大学学报, 2023, 41(1): 67-70. LIANG J L, XU E X, LI D F, et al. Application effect of multidisciplinary collaborative cardiopulmonary rehabilitation in patients with severe pneumonia during the ICU transition[J]. Journal of Guangdong Medical University, 2023, 41(1): 67-70.
[17]	CAMERON N, JONES P R, MOODIE A, et al. Timing and magnitude of adolescent growth in height and weight in Cape coloured children after Kwashiorkor[J]. J Pediatr, 1986, 109(3): 548-555. doi: 10.1016/S0022-3476(86)80142-1
[18]	孙娟, 李岩, 郑蔚, 等. 基于时机理论的赋能教育在PCI手术患者中的应用[J]. 护理学报, 2022, 29(2): 73-78 SUN J, LI Y, ZHENG W, et al. Application of Timing Theory-Based Empowerment Education in PCI Surgery Patients[J]. J Nurs Sci, 2022, 29(2): 73-78
[19]	郑爱娣, 王咏梅, 徐静, 等. 基于时机理论的延续护理在房颤合并慢性心力衰竭患者中的应用[J]. 中华全科医学, 2022, 20(7): 1259-1262. doi: 10.16766/j.cnki.issn.1674-4152.002572 ZHENG A D, WANG Y M, XU J, et al. Application of continuous nursing based on timing theory in patients with atrial fibrillation and chronic heart failure[J]. Chinese Journal of General Practice, 2022, 20(7): 1259-1262. doi: 10.16766/j.cnki.issn.1674-4152.002572
[20]	柯静, 曹斌, 蒋志锋, 等. 多学科协作诊疗模式在新型冠状病毒肺炎患者诊疗中的价值[J]. 首都医科大学学报, 2020, 41(2): 298-301. KE J, CAO B, JIANG Z F, et al. Value of multidisciplinary cooperation model in the treatment of COVID-19[J]. J Capital Med Univ, 2020, 41(2): 298-301.