作者：林志星，韩亮，钟昌会，庄亚萍，林成寿，王珊珊

单位：

1.海南医学院第一附属医院重症医学科2.海南医学院第一附属医院康复医学科

Units：

Department of Critical Care Medicine, the First Affiliated Hospital of Hainan Medical College;Department of Rehabilitation Medicine, the First Affiliated Hospital of Hainan Medical College;

关键词：

脓毒症; 呼吸,人工; 心肺康复; 心肺功能;

Keywords：

Sepsis;Respiration,artificial;Cardiopulmonary rehabilitation;Cardiopulmonary function;

CLC：

DOI：

10.12114/j.issn.1008-5971.2022.00.309

Funds：

海南省卫生健康行业科研项目（21A200054）；

摘要：

目的 探讨早期分阶梯心肺康复治疗脓毒症机械通气患者的效果。方法 选取2021年1月至2022年1月在海南医学院第一附属医院住院的脓毒症患者76例，采用随机数字表法分为对照组与研究组，每组38例。对照组采用常规治疗，研究组在对照组基础上联合早期分阶梯心肺康复治疗。比较两组一般资料、治疗前后炎症因子、治疗前后心肺功能指标、治疗时间、并发症发生情况、撤机情况及预后。结果 两组治疗后肿瘤坏死因子α(TNF-α)、IL-6、IL-10分别低于本组治疗前，且研究组治疗后TNF-α、IL-6、IL-10低于对照组（P<0.05）。治疗后研究组心脏指数高于本组治疗前，D-二聚体低于本组治疗前（P<0.05）；两组治疗后氧合指数分别高于本组治疗前，心肌肌钙蛋白I分别低于本组治疗前，且研究组治疗后心脏指数、氧合指数高于对照组，心肌肌钙蛋白I、D-二聚体低于对照组（P<0.05）。两组ICU获得性衰弱发生率、撤机失败率比较，差异无统计学差异（P>0.05）；研究组机械通气时间、ICU住院时间、总住院时间短于对照组，呼吸机相关性肺炎、气管切开发生率及住院期间死亡率低于对照组（P<0.05）。结论 早期分阶梯心肺康复治疗可明显降低脓毒症机械通气患者血清炎症因子水平，改善患者心肺功能，缩短住院时间，减少呼吸机相关性肺炎等并发症发生风险及住院期间死亡风险，改善患者预后，值得临床推广应用。

Abstract：

Objective To investigate the effect of early staged cardiopulmonary rehabilitation in the treatment of mechanically ventilated patients with sepsis. Methods A total of 76 patients with sepsis hospitalized in the First Affiliated Hospital of Hainan Medical College from January 2021 to January 2022 were selected and divided into control group and random group according to the random number table method, with 38 cases in each group. The control group was treated with conventional method, while the study group was treated with early staged cardiopulmonary rehabilitation on the basis of the control group. The general data, inflammatory factors and cardiopulmonary function indexes before and after treatment, treatment time, complications, weaning situation and prognosis were compared between the two groups. Results After treatment, the levels of tumor necrosis factor-α（TNF-α）, IL-6 and IL-10 in the two groups were lower than those before treatment respectively, and the levels of TNF-α, IL-6 and IL-10 in the study group were lower than those in the control group（P < 0.05）. The cardiac index of the study group after treatment was higher than that before treatment, and the D-dimer was lower than that before treatment（P < 0.05）. After the treatment, the oxygenation index of the two groups was higher that than before the treatment, and the cardiac troponin I was lower than that before the treatment, and the cardiac index and oxygenation index of the study group were higher than those of the control group, the myocardial troponin I and D-dimer were lower than those of the control group（P < 0.05）. There were no significant differences in the incidence of ICU-acquired frailty and weaning failure rate between the two groups（P > 0.05）. The duration of mechanical ventilation, length of ICU stay and total length of hospital stay in the study group were shorter than those in the control group, the incidences of ventilator-associated pneumonia, tracheotomy and death during hospitalization in the study group were lower than those in the control group（P < 0.05）. Conclusion Early staged cardiopulmonary rehabilitation can significantly reduce the level of serum inflammatory factors of mechanically ventilated patients with sepsis, improve the cardiopulmonary function of patients, shorten the hospital stay, reduce the risk of complications such as ventilator-associated pneumonia and death during hospitalization, and improve the prognosis, which is worthy of clinical application.

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