标题：早期综合肺康复干预对综合 ICU呼吸机相关性肺炎的防控效果

      作者：朱伟伟 1，张金换 2，万健 2，范叶君 2    1.静安区闸北中心医院重症监护室，上海 200070；2.上海市浦东新区人民医院急诊与重症医学科，上海 201299

      卷次： 2020年31卷4期

      【摘要】 目的 探讨早期综合肺康复干预对综合 ICU耐碳青霉烯类肺炎克雷伯菌致呼吸机相关性肺炎(VAP)的防控效果。方法 选取上海静安区闸北中心医院 ICU科2017年4月至2018年5月行机械通气治疗的80例患者作为观察对象，按随机数表法分为观察组和对照组，每组40例，观察组予以早期综合肺康复干预，对照组予以常规康复干预。比较两组患者的VAP发生率、撤机时间和住院时间。结果 观察组患者的VAP发生率为2.50%，明显低于对照组的15.0%，差异有统计学意义(P<0.05)；观察组和对照组患者的撤机时间[(6.13±1.18) d vs (8.36±1.20) d]与住院时间[(12.15±1.22) d vs (16.98±1.36) d]比较，观察组明显短于对照组，差异均有统计学意义(P<0.05)；观察组和对照组患者的 pH值(7.36±0.17 vs 7.28±0.13)、血氧分压(PaO2) [(90.09±8.01) mmHg vs (75.13±15.48) mmHg]、血氧饱和度(SpO2) [(96.17±3.12)% vs (91.69±3.89)%]比较，观察组明显高于对照组；二氧化碳分压(PaCO2) [(38.61±12.92) mmHg vs (46.51±13.13) mmHg]比较，观察组明显低于对照组，差异均有统计学意义(P<0.05)。结论 早期综合肺康复干预可以显著降低机械通气患者的VAP发生率，改善患者的血气情况，进而促进患者恢复、缩短患者病程，具有临床推广价值。
      【关键词】 早期综合肺康复干预；综合重症监护室；耐碳青霉烯类肺炎克雷伯菌；呼吸机相关性肺炎；防控
      【中图分类号】 R563.1 【文献标识码】 A 【文章编号】 1003—6350（2020）04—0542—03

Prevention and control effect of early comprehensive lung rehabilitation intervention on ventilator-associatedpneumonia caused by carbapenem-resistant Klebsiella pneumoniae in comprehensive ICU.
ZHU Wei-wei 1, ZHANGJin-huan 2, WAN Jian 2, FAN Ye-jun 2. 1. Intensive Care Unit, Shanghai Jing'an District Zhabei Central Hospital, Shanghai200070, CHINA; 2. Emergency and Critical Medicine Department, Shanghai Pudong New District People's Hospital,Shanghai 201299, CHINA
【Abstract】 Objective To explore the effect of early comprehensive pulmonary rehabilitation intervention onventilators-associated pneumonia caused by carbapenem-resistant Klebsiella pneumoniae in the comprehensive ICU.Methods Eighty patients treated with mechanical ventilation in Intensive Care Unit, Shanghai Jing'an District ZhabeiCentral Hospital from April 2017 to May 2018 were selected as the research subjects. According to the random numbertable, the patients were divided into the observation group and the control group, with 40 patients in each group. The ob-servation group received early comprehensive pulmonary rehabilitation intervention, and the control group received rou-tine rehabilitation intervention. The incidence of VAP, withdrawal time, and length of hospital stay were compared be-tween the two groups. Results The incidence of VAP in the observation group was 2.50%, significantly lower than15.0% in the control group (P<0.05). The withdrawal time and length of hospital stay in the observation group were sig-nificantly shorter than those in the control group (P<0.05): (6.13±1.18) d vs (8.36±1.20) d, (12.15±1.22) d vs (16.98±1.36) d. The pH value, PaO2, and SpO2 of the observation group were significantly higher than those of the control group(P<0.05): (7.36±0.17) vs (7.28±0.13), (90.09±8.01) mmHg vs (75.13±15.48) mmHg, (96.17±3.12)% vs (91.69±3.89)%.PaCO2 in the observation group was significantly lower than that in the control group (P<0.05): (38.61±12.92) mmHg vs(46.51±13.13) mmHg. Conclusion Early comprehensive pulmonary rehabilitation intervention can significantly reducethe incidence of VAP in patients with mechanical ventilation, improve the patients' blood and gas conditions, and thuspromote the patients' recovery and shorten the course of disease, which has the value of clinical promotion.
      【Key words】 Early comprehensive pulmonary rehabilitation intervention; Comprehensive intensive care unit;Carbapenem-resistant Klebsiella pneumoniae; Ventilator-associated pneumonia; Prevention and control·护理·doi:10.3969/j.issn.1003-6350.2020.04.036基金项目：上海市浦东新区临床医学重点专科建设项目(编号：PWZzk2017-22)