氣道廓清術在腦卒中相關性肺炎氣管切開患者康復中的應用_Chinese Journal of Respiratory and Critical Care Medicine

Authors：

梁天佳 ,  莫明玉 , 周開斌 , 廖明珍 , 寧育藝 , 李智敏

廣西醫科大學第二附屬醫院康復醫學科（廣西南寧 530007）;

Corresponding?author：

莫明玉, Email: 751081955@qq.com

Keywords：

氣道廓清術; 腦卒中相關性肺炎; 氣管切開; 肺康復

DOI：

10.7507/1671-6205.202005097

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目的觀察氣道廓清技術對腦卒中相關性肺炎氣管切開患者的臨床療效。方法將 60 例腦卒中相關性肺炎氣管切開患者按隨機數字表法分為觀察組和對照組。觀察組在常規治療的基礎上給予氣道廓清技術排痰，對照組給予常規治療和傳統體位引流排痰。記錄患者體溫、外周血白細胞計數、排痰量、氣體交換指數及胸部 X 線片浸潤情況，比較組間臨床肺部感染評分（CPIS）、氣管套管拔管時間、拔管成功率及臨床療效的差異。結果干預第 2、3 周后，觀察組的 CPIS 評分較對照組均明顯降低（P<0.05）；干預第 4 周后，觀察組的 CPIS 評分較對照組顯著降低（P<0.01）；與干預前相比，從第 2 周開始，隨著干預周數的增加，觀察組 CPIS 評分降低越顯著（P<0.01），而對照組至第 4 周 CPIS 評分才顯著降低（P<0.01）。干預 4 周結束后，觀察組顯效 23 例，有效 6 例，無效 1 例；對照組顯效 13 例，有效 16 例，無效 1 例，組間差異有統計學意義（P<0.05）。干預后觀察組患者拔管成功率明顯高于對照組（P<0.05），觀察組拔管時間比對照組顯著縮短（P<0.01）。結論氣道廓清技術能有效減少腦卒中相關性肺炎氣管切開患者痰液，改善患者的缺氧癥狀，有利于縮短拔管時間，減少并發癥的發生，提高拔管成功率，促進患者的康復。

Citation： 梁天佳, 莫明玉, 周開斌, 廖明珍, 寧育藝, 李智敏. 氣道廓清術在腦卒中相關性肺炎氣管切開患者康復中的應用. Chinese Journal of Respiratory and Critical Care Medicine, 2021, 20(4): 270-273. doi: 10.7507/1671-6205.202005097 Copy

1.	葛慧青, 孫兵, 王波, 等. 重癥患者氣道廓清技術專家共識. 中華重癥醫學電子雜志(網絡版), 2020, 6(3): 272-282.
2.	Strickland SL, Rubin BK, Drescher GS, et al. AARC clinical practice guideline: effectiveness of nonpharmacologic airway clearance therapies in hospitalized patient. Respir Care, 2013, 58(12): 2187-2193.
3.	王擁軍, 陳玉國, 呂傳柱, 等. 卒中相關性肺炎診治中國專家共識(2019 更新版). 中國卒中雜志, 2019, 14(12): 1251-1262.
4.	Westerdahl E, Osadnik C, Emtner M. Airway clearance techniques for patients with acute exacerbations of chronic obstructive pulmonary disease: physical therapy practice in Sweden. Chron Respir Dis, 2019, 16: 511-518.
5.	石宏哲, 秦錚, 池衛華, 等. 重癥肺炎 MSCT 圖像征象、臨床肺部感染評分與病情嚴重程度的相關性研究. 中國 CT 和 MRI 雜志, 2019, 17(7): 79-81.
6.	Ewig S, H?ffken G, Kern WV, et al. Behandlung von erwachsenen Patienten mit ambulant erworbener Pneumonie und Pr?vention - Update 2016 [Management of Adult Community-acquired Pneumonia and Prevention - Update 2016]. Pneumologie, 2016, 70(3): 151-200.
7.	丁玉菊, 徐紹俠, 張偉, 等. 神經重癥氣管切開患者拔管臨床指征的Meta分析. 中華危重病急救醫學, 2019, 31(11): 1378-1383.
8.	Hilker R, Poetter C, Findeisen N, et al. Nosocomial pneumonia after acute stroke: implications for neurological intensive care medicine. Stroke, 2003, 34(4): 975-981.
9.	Smith CJ, Kishore AK, Vail A, et al. Diagnosis of stroke-associated pneumonia: recommendations from the Pneumonia in Stroke Consensus Group. Stroke, 2015, 46(8): 2335-2340.
10.	Sari IM, Soertidewi L, Yokota C, et al. Comparison of characteristics of stroke-associated pneumonia in stroke care units in Indonesia and Japan. J Stroke Cerebrovasc Dis, 2017, 26(2): 280-285.
11.	Teh WH, Smith CJ, Barlas RS, et al. Impact of stroke-associated pneumonia on mortality, length of hospitalization, and functional outcome. Acta Neurol Scand, 2018, 138(4): 293-300.
12.	Barlas RS, Clark AB, Bettencourt-Silva JH, et al. Pneumonia and risk of serious adverse outcomes in hospitalized strokes in Thailand. J Stroke Cerebrovasc Dis, 2019, 28(6): 1448-1454.
13.	Ali AN, Howe J, Majid A, et al. The economic cost of stroke-associated pneumonia in a UK setting. Top Stroke Rehabil, 2018, 25(3): 214-223.
14.	Lakshminarayan K, Tsai AW, Tong X, et al. Utility of dysphagia screening results in predicting poststroke pneumonia. Stroke, 2010, 41(12): 2849-2854.
15.	Sui R, Zhang L. Risk factors of stroke-associated pneumonia in Chinese patients. Neurol Res, 2011, 33(5): 508-513.
16.	Bosel J. Tracheostomy in stroke patients. Curr Treat Options Neurol, 2014, 16(1): 274.
17.	Su X, Li Z, Wang M, et al. The protective effect of different airway humidification liquids to lung after tracheotomy in traumatic brain injury: the role of pulmonary surfactant protein-A (SP-A). Gene, 2016, 577(1): 89-95.
18.	Dziewas R, Stellato R, van der Tweel I, et al. Pharyngeal electrical stimulation for early decannulation in tracheotomised patients with neurogenic dysphagia after stroke (PHAST-TRAC): a prospective, single-blinded, randomised trial. Lancet Neurol, 2018, 17(10): 849-859.
19.	Perin C, Meroni R, Rega V, et al. Parameters influencing tracheostomy decannulation in patients undergoing rehabilitation after severe acquired brain injury (sABI). Int Arch Otorhinolaryngol, 2017, 21(4): 382-389.
20.	Park MK, Lee SJ. Changes in swallowing and cough functions among stroke patients before and after tracheostomy decannulation. Dysphagia, 2018, 33(6): 857-865.
21.	黃岳, 崔利華, 劉麗旭, 等. 腦卒中患者的呼吸功能障礙及其康復. 中國康復理論與實踐, 2015, 2l(9): 1055-1057.
22.	譚旭, 許娟, 羅薇娜, 等. 兩種氣道廓清技術在慢性阻塞性肺疾病急性加重病人中的應用效果比較. 護理研究, 2020, 34(9): 1662-1665.
23.	華玉平, 馮重睿, 符碧洲, 等. 探討主動呼吸循環技術對腦卒中氣管切開術后患者呼吸功能的療效. 中國康復, 2018, 33(2): 136-137.
24.	Enrichi C, Battel I, Zanetti C, et al. Clinical criteria for tracheostomy decannulation in subjects with acquired brain injury. Respir Care, 2017, 62(10): 1255-1263.
25.	高天敏, 周全昌, 黃仕聰, 等. 三球式呼吸訓練器在慢性阻塞性肺疾病患者肺康復中的應用研究. 重慶醫學, 2015, 44(32): 4514-4516.
26.	李群, 陳鋒, 王曉霞, 等. 肺康復訓練對不同嚴重度穩定期慢性阻塞性肺疾病的影響. 中國呼吸與危重監護雜志, 2013, 12(2): 130-135.
27.	Flude LJ, Agent P, Bilton D. Chest physiotherapy techniques in bronchiectasis. Clin Chest Med, 2012, 33(2): 351-361.

1. 葛慧青, 孫兵, 王波, 等. 重癥患者氣道廓清技術專家共識. 中華重癥醫學電子雜志(網絡版), 2020, 6(3): 272-282.
2. Strickland SL, Rubin BK, Drescher GS, et al. AARC clinical practice guideline: effectiveness of nonpharmacologic airway clearance therapies in hospitalized patient. Respir Care, 2013, 58(12): 2187-2193.
3. 王擁軍, 陳玉國, 呂傳柱, 等. 卒中相關性肺炎診治中國專家共識(2019 更新版). 中國卒中雜志, 2019, 14(12): 1251-1262.
4. Westerdahl E, Osadnik C, Emtner M. Airway clearance techniques for patients with acute exacerbations of chronic obstructive pulmonary disease: physical therapy practice in Sweden. Chron Respir Dis, 2019, 16: 511-518.
5. 石宏哲, 秦錚, 池衛華, 等. 重癥肺炎 MSCT 圖像征象、臨床肺部感染評分與病情嚴重程度的相關性研究. 中國 CT 和 MRI 雜志, 2019, 17(7): 79-81.
6. Ewig S, H?ffken G, Kern WV, et al. Behandlung von erwachsenen Patienten mit ambulant erworbener Pneumonie und Pr?vention - Update 2016 [Management of Adult Community-acquired Pneumonia and Prevention - Update 2016]. Pneumologie, 2016, 70(3): 151-200.
7. 丁玉菊, 徐紹俠, 張偉, 等. 神經重癥氣管切開患者拔管臨床指征的Meta分析. 中華危重病急救醫學, 2019, 31(11): 1378-1383.
8. Hilker R, Poetter C, Findeisen N, et al. Nosocomial pneumonia after acute stroke: implications for neurological intensive care medicine. Stroke, 2003, 34(4): 975-981.
9. Smith CJ, Kishore AK, Vail A, et al. Diagnosis of stroke-associated pneumonia: recommendations from the Pneumonia in Stroke Consensus Group. Stroke, 2015, 46(8): 2335-2340.
10. Sari IM, Soertidewi L, Yokota C, et al. Comparison of characteristics of stroke-associated pneumonia in stroke care units in Indonesia and Japan. J Stroke Cerebrovasc Dis, 2017, 26(2): 280-285.
11. Teh WH, Smith CJ, Barlas RS, et al. Impact of stroke-associated pneumonia on mortality, length of hospitalization, and functional outcome. Acta Neurol Scand, 2018, 138(4): 293-300.
12. Barlas RS, Clark AB, Bettencourt-Silva JH, et al. Pneumonia and risk of serious adverse outcomes in hospitalized strokes in Thailand. J Stroke Cerebrovasc Dis, 2019, 28(6): 1448-1454.
13. Ali AN, Howe J, Majid A, et al. The economic cost of stroke-associated pneumonia in a UK setting. Top Stroke Rehabil, 2018, 25(3): 214-223.
14. Lakshminarayan K, Tsai AW, Tong X, et al. Utility of dysphagia screening results in predicting poststroke pneumonia. Stroke, 2010, 41(12): 2849-2854.
15. Sui R, Zhang L. Risk factors of stroke-associated pneumonia in Chinese patients. Neurol Res, 2011, 33(5): 508-513.
16. Bosel J. Tracheostomy in stroke patients. Curr Treat Options Neurol, 2014, 16(1): 274.
17. Su X, Li Z, Wang M, et al. The protective effect of different airway humidification liquids to lung after tracheotomy in traumatic brain injury: the role of pulmonary surfactant protein-A (SP-A). Gene, 2016, 577(1): 89-95.
18. Dziewas R, Stellato R, van der Tweel I, et al. Pharyngeal electrical stimulation for early decannulation in tracheotomised patients with neurogenic dysphagia after stroke (PHAST-TRAC): a prospective, single-blinded, randomised trial. Lancet Neurol, 2018, 17(10): 849-859.
19. Perin C, Meroni R, Rega V, et al. Parameters influencing tracheostomy decannulation in patients undergoing rehabilitation after severe acquired brain injury (sABI). Int Arch Otorhinolaryngol, 2017, 21(4): 382-389.
20. Park MK, Lee SJ. Changes in swallowing and cough functions among stroke patients before and after tracheostomy decannulation. Dysphagia, 2018, 33(6): 857-865.
21. 黃岳, 崔利華, 劉麗旭, 等. 腦卒中患者的呼吸功能障礙及其康復. 中國康復理論與實踐, 2015, 2l(9): 1055-1057.
22. 譚旭, 許娟, 羅薇娜, 等. 兩種氣道廓清技術在慢性阻塞性肺疾病急性加重病人中的應用效果比較. 護理研究, 2020, 34(9): 1662-1665.
23. 華玉平, 馮重睿, 符碧洲, 等. 探討主動呼吸循環技術對腦卒中氣管切開術后患者呼吸功能的療效. 中國康復, 2018, 33(2): 136-137.
24. Enrichi C, Battel I, Zanetti C, et al. Clinical criteria for tracheostomy decannulation in subjects with acquired brain injury. Respir Care, 2017, 62(10): 1255-1263.
25. 高天敏, 周全昌, 黃仕聰, 等. 三球式呼吸訓練器在慢性阻塞性肺疾病患者肺康復中的應用研究. 重慶醫學, 2015, 44(32): 4514-4516.
26. 李群, 陳鋒, 王曉霞, 等. 肺康復訓練對不同嚴重度穩定期慢性阻塞性肺疾病的影響. 中國呼吸與危重監護雜志, 2013, 12(2): 130-135.
27. Flude LJ, Agent P, Bilton D. Chest physiotherapy techniques in bronchiectasis. Clin Chest Med, 2012, 33(2): 351-361.

Chinese Journal of Respiratory and Critical Care Medicine

氣道廓清術在腦卒中相關性肺炎氣管切開患者康復中的應用

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