胸部物理干预在预防重型颅脑创伤呼吸机相关性肺炎中的应用研究

目的研究胸部物理干预(CPI)在预防重型颅脑创伤(STBI)呼吸机相关性肺炎(VAP)中的应用效果。方法采用回顾性对照研究分析。2015年7月-2019年6月成都医学院第一附属医院ICU收治STBI患者156例临床资料,男性97例,女性59例;年龄22~70岁,平均44.73岁。依照干预方法分为CPI组(n=87)与对照组(n=69)。对照组给予常规干预,CPI组给予常规干预+CPI。CPI:胸部叩击、手法振动、膨肺、机械吸引、使用振动排痰机。观察两组脱机、发生VAP及出ICU后30d内死亡情况,记录机械通气时间、出现VAP时间、入住ICU时间及住院时间。干预前后氧合指数(OI)、血氧饱和度(SpO2)、急性生理及慢性健康状况评分II(APACHE II)、临床肺部感染积分(CPIS),血清白介素-8(IL-8)、白介素-10(IL-10)及高迁移率蛋白B1(HMGB1)等炎性因子。结果 CPI组成功脱机率高于对照组(94.25%vs. 71.01%),VAP发生率及出ICU后30d内病死率低于对照组(22.99%vs. 46.38%,15.94%vs. 30.43%,P<0.05)。CPI组出现VAP时间多于对照组(4.97±0.53)d vs.(3.59±0.38)d],机械通气时间、入住ICU时间及住院时间均少于对照组(9.36±0.95)d vs.(12.86±1.47)d,(15.64±1.65)d vs.(19.08±2.43)d,(19.97±2.18)d vs.(28.75±3.19)d,P<0.05]。干预后,CPI组OI、SpO2均大于对照组(357.98±37.93)mmHg vs.(326.97±34.75)mmHg,(99.78±10.19)%vs.(95.46±9.86)%],APACHE II、CPIS、IL-8、IL-10、HMGB1均低于对照组(13.88±1.53)分vs.(15.96±1.75)分,(2.64±0.08)分vs.(3.21±0.34)分,(18.27±2.19)ng/L vs.(22.98±2.37)ng/L,(10.28±1.16)ng/L vs.(12.63±1.38)ng/L,(42.97±4.41)pg/mL vs.(50.86±5.18)pg/mL,P<0.05]。结论 CPI可有效促进STBI患者痰液排出,减少炎性因子生成,改善肺功能,降低VAP发生率,促进患者转归。

Application research of chest physical intervention in prevention of ventilators associated pneumonia in severe traumatic brain injury

Objective To study the application of chest physical intervention(CPI) in prevention of ventilators associated pneumonia(VAP) in severe traumatic brain injury(STBI). Methods Totally 156 patients with STBI admitted to ICU of our hospital from Jul. 2015 to Jun. 2019 were selected and divided into CPI group(n=87) and control group(n=69) according to the intervention technique. The control group received conventional intervention,and the CPI group received conventional intervention+CPI. There were 97 males,59 females,with an average age of 44.73 years(range,22-70 years).The machine removal,VAP and death rate within 30 days after ICU,mechanical ventilation time,VAP time,ICU stay time and hospitalization time of the two groups were observed. Before and after intervention,oxygenation index(OI),oxygen saturation(SpO2),acute physiology and chronic health evaluation II(APACHE II),clinical pulmonary infection score(CPIS),and inflammatory factors such as serum interleukin-8(IL-8),interleukin-10(IL-10) and high mobility group box B1(HMGB1) were observed. Results The machine removal rate in the CPI group was more than that in the control group.The VAP rate and death rate within 30 days after ICU in the CPI group were less than those in the control group(P < 0.05). The VAP time in the CPI group was more than that in the control group,and the mechanical ventilation time,ICU stay time and hospitalization time were less than those in the control group(P<0.05). After intervention,OI and SpO2 in the CPI group were higher than those in the control group,and APACHEII,CPIS,IL-8,IL-10 and HMGB1 in the CPI group were lower than those in the control group(P<0.05). Conclusion CPI can effectively promote sputum discharge in STBI patients,relieve body stress,reduce the production of inflammatory factors,improve lung function,reduce the incidence of VAP,and promote patients’ prognosis.