气道廓清术在脑卒中相关性肺炎气管切开患者康复中的应用_Chinese Journal of Respiratory and Critical Care Medicine

Authors：

梁天佳 ,  莫明玉 , 周开斌 , 廖明珍 , 宁育艺 , 李智敏

广西医科大学第二附属医院康复医学科（广西南宁 530007）;

Corresponding author：

莫明玉, Email: 751081955@qq.com

Keywords：

气道廓清术; 脑卒中相关性肺炎; 气管切开; 肺康复

DOI：

10.7507/1671-6205.202005097

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目的观察气道廓清技术对脑卒中相关性肺炎气管切开患者的临床疗效。方法将 60 例脑卒中相关性肺炎气管切开患者按随机数字表法分为观察组和对照组。观察组在常规治疗的基础上给予气道廓清技术排痰，对照组给予常规治疗和传统体位引流排痰。记录患者体温、外周血白细胞计数、排痰量、气体交换指数及胸部 X 线片浸润情况，比较组间临床肺部感染评分（CPIS）、气管套管拔管时间、拔管成功率及临床疗效的差异。结果干预第 2、3 周后，观察组的 CPIS 评分较对照组均明显降低（P<0.05）；干预第 4 周后，观察组的 CPIS 评分较对照组显著降低（P<0.01）；与干预前相比，从第 2 周开始，随着干预周数的增加，观察组 CPIS 评分降低越显著（P<0.01），而对照组至第 4 周 CPIS 评分才显著降低（P<0.01）。干预 4 周结束后，观察组显效 23 例，有效 6 例，无效 1 例；对照组显效 13 例，有效 16 例，无效 1 例，组间差异有统计学意义（P<0.05）。干预后观察组患者拔管成功率明显高于对照组（P<0.05），观察组拔管时间比对照组显著缩短（P<0.01）。结论气道廓清技术能有效减少脑卒中相关性肺炎气管切开患者痰液，改善患者的缺氧症状，有利于缩短拔管时间，减少并发症的发生，提高拔管成功率，促进患者的康复。

Citation： 梁天佳, 莫明玉, 周开斌, 廖明珍, 宁育艺, 李智敏. 气道廓清术在脑卒中相关性肺炎气管切开患者康复中的应用. Chinese Journal of Respiratory and Critical Care Medicine, 2021, 20(4): 270-273. doi: 10.7507/1671-6205.202005097 Copy

1.	葛慧青, 孙兵, 王波, 等. 重症患者气道廓清技术专家共识. 中华重症医学电子杂志(网络版), 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.	王拥军, 陈玉国, 吕传柱, 等. 卒中相关性肺炎诊治中国专家共识(2019 更新版). 中国卒中杂志, 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, 秦铮, 池卫华, 等. 重症肺炎 MSCT 图像征象、临床肺部感染评分与病情严重程度的相关性研究. 中国 CT 和 MRI 杂志, 2019, 17(7): 79-81.
6.	Ewig S, Höffken G, Kern WV, et al. Behandlung von erwachsenen Patienten mit ambulant erworbener Pneumonie und Prävention - Update 2016 [Management of Adult Community-acquired Pneumonia and Prevention - Update 2016]. Pneumologie, 2016, 70(3): 151-200.
7.	丁玉菊, 徐绍侠, 张伟, 等. 神经重症气管切开患者拔管临床指征的Meta分析. 中华危重病急救医学, 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.	黄岳, 崔利华, 刘丽旭, 等. 脑卒中患者的呼吸功能障碍及其康复. 中国康复理论与实践, 2015, 2l(9): 1055-1057.
22.	谭旭, 许娟, 罗薇娜, 等. 两种气道廓清技术在慢性阻塞性肺疾病急性加重病人中的应用效果比较. 护理研究, 2020, 34(9): 1662-1665.
23.	华玉平, 冯重睿, 符碧洲, 等. 探讨主动呼吸循环技术对脑卒中气管切开术后患者呼吸功能的疗效. 中国康复, 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, 黄仕聪, 等. 三球式呼吸训练器在慢性阻塞性肺疾病患者肺康复中的应用研究. 重庆医学, 2015, 44(32): 4514-4516.
26.	李群, 陈锋, 王晓霞, 等. 肺康复训练对不同严重度稳定期慢性阻塞性肺疾病的影响. 中国呼吸与危重监护杂志, 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, 孙兵, 王波, 等. 重症患者气道廓清技术专家共识. 中华重症医学电子杂志(网络版), 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. 王拥军, 陈玉国, 吕传柱, 等. 卒中相关性肺炎诊治中国专家共识(2019 更新版). 中国卒中杂志, 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, 秦铮, 池卫华, 等. 重症肺炎 MSCT 图像征象、临床肺部感染评分与病情严重程度的相关性研究. 中国 CT 和 MRI 杂志, 2019, 17(7): 79-81.
6. Ewig S, Höffken G, Kern WV, et al. Behandlung von erwachsenen Patienten mit ambulant erworbener Pneumonie und Prävention - Update 2016 [Management of Adult Community-acquired Pneumonia and Prevention - Update 2016]. Pneumologie, 2016, 70(3): 151-200.
7. 丁玉菊, 徐绍侠, 张伟, 等. 神经重症气管切开患者拔管临床指征的Meta分析. 中华危重病急救医学, 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. 黄岳, 崔利华, 刘丽旭, 等. 脑卒中患者的呼吸功能障碍及其康复. 中国康复理论与实践, 2015, 2l(9): 1055-1057.
22. 谭旭, 许娟, 罗薇娜, 等. 两种气道廓清技术在慢性阻塞性肺疾病急性加重病人中的应用效果比较. 护理研究, 2020, 34(9): 1662-1665.
23. 华玉平, 冯重睿, 符碧洲, 等. 探讨主动呼吸循环技术对脑卒中气管切开术后患者呼吸功能的疗效. 中国康复, 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, 黄仕聪, 等. 三球式呼吸训练器在慢性阻塞性肺疾病患者肺康复中的应用研究. 重庆医学, 2015, 44(32): 4514-4516.
26. 李群, 陈锋, 王晓霞, 等. 肺康复训练对不同严重度稳定期慢性阻塞性肺疾病的影响. 中国呼吸与危重监护杂志, 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

气道廓清术在脑卒中相关性肺炎气管切开患者康复中的应用

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