A prospective randomized controlled study on the effects of early mobilization therapy on gastrointestinal function and respiratory mechanics in mechanical ventilation patients with chronic obstructive pulmonary disease
10.3760/cma.j.issn.1673-4904.2018.07.006
- VernacularTitle:早期运动治疗对慢性阻塞性肺疾病机械通气患者胃肠功能和呼吸力学影响的前瞻性随机对照研究
- Author:
Jinggang LIU
1
;
Suqiu MENG
;
Guizhen ZHANG
;
Jiyin YUAN
;
Jihua LIU
;
Shengqiang YANG
Author Information
1. 274300,济宁医学院附属湖西医院(山东省单县中心医院)重症医学科
- Keywords:
Pulmonary disease,chronic obstructive;
Respiration,artificial;
Exercise therapy;
Respiratory mechanics;
Prospective studies
- From:
Chinese Journal of Postgraduates of Medicine
2018;41(7):600-605
- CountryChina
- Language:Chinese
-
Abstract:
Objective To investigate the effects of early mobilization therapy on gastrointestinal function and respiratory mechanics in mechanical ventilation patients with chronic obstructive pulmonary disease (COPD). Methods A prospective randomized controlled study was used. Eighty-five patients with COPD who had stable hemodynamics and required invasive mechanical ventilation from January to December 2017 were enrolled. The patients were divided into treatment group with 43 cases and control group with 42 cases according to the random number table method. The patients in both groups received conventional basic treatment, but the treatment group received early mobilization therapy. The conditions of acute gastrointestinal injury (AGI), incidence of ventilator-associated pneumonia (VAP), duration of mechanical ventilation, 28-day mortality and respiratory mechanics indexes before and after treatment including airway resistance (Raw), lung dynamic compliance (Cd), lung static compliance (Cs), intrinsic positive end expiratory pressure (PEEPi) were compared between 2 groups. Results There were no statistical difference in Raw, Cd, Cs and PEEPi before treatment between 2 groups (P＞0.05). The PEEPi and Raw after treatment in treatment group were significantly lower than those in control group:(6.51 ± 1.46) cmH2O (1 cmH2O=0.098 kPa) vs. (7.30 ± 1.61) cmH2O and (19.23 ± 2.62) cmH2O/(L·s) vs. (20.54 ± 2.50) cmH2O/(L·s), the Cs and Cd were significantly higher than those in control group:(53.14 ± 5.07) ml/cmH2O vs. (49.16 ± 5.10) ml/cmH2O and (26.63 ± 3.28) ml/cmH2O vs. (24.54 ± 1.97) ml/cmH2O, and there were statistical differences (P＜0.05 or＜0.01). The incidences of AGI, duration of AGI, duration of mechanical ventilation and incidence of VAP in treatment group were significantly lower than those in control group: 44.2% (19/43) vs. 66.7% (28/42), (3.56 ± 1.22) d vs. (4.26 ± 1.62) d, (6.79 ± 1.92) d vs. (7.64 ± 1.89) d and 2.3% (1/43) vs. 14.3% (6/42), the severity of AGI was significantly lower than that in control group (patients of gradeⅠ,Ⅱ,ⅢandⅣin treatment group were 11, 6, 1 and 1 case respectively, and patients of grade Ⅰ, Ⅱ, Ⅲ and Ⅳ in control group were 7, 12, 8 and 1 case respectively), and there were statistical differences (P＜0.05). There was statistical difference in 28-day mortality between 2 groups (P＞0.05). Conclusions The incidence of AGI in mechanical ventilation patients with COPD is high. Early mobilization therapy can reduce the incidence and duration of AGI in mechanically ventilated patients with COPD, and reduce airway resistance, increase Cd and Cs, reduce PEEPi, improve respiratory function, shorten mechanical ventilation time, and reduce the incidence of VAP, which is worthy of clinical promotion.
