俯卧位联合呼吸训练在脑出血合并肺功能低下患者中的早期应用研究

Early Application of Prone Position Ventilation Combined with Respiratory Training in Patients with Intracerebral Hemorrhage and Pulmonary Hypopnea

摘要: 目的：探讨俯卧位通气联合呼吸训练在脑出血合并肺功能低下患者早期康复中的应用效果及安全性。方法：采用前瞻性随机对照研究设计，选取2022年6月至2025年6月在我院神经外科重症监护病房收治的脑出血合并肺功能低下患者120例，按照随机数字表法分为观察组和对照组各60例。对照组实施常规护理及基础呼吸训练，观察组在常规护理基础上实施俯卧位通气联合系统化呼吸训练。比较两组患者干预前后肺功能指标、血气分析指标、肺部感染发生率、机械通气时间、ICU住院时间及神经功能恢复情况。结果：干预后观察组患者用力肺活量(FVC)、第1秒用力呼气容积(FEV1)、峰值呼气流速(PEF)、最大吸气压(MIP)均显著优于对照组(P < 0.05)；动脉血氧分压(PaO₂)和氧合指数(PaO₂/FiO₂)明显高于对照组，动脉血二氧化碳分压(PaCO₂)显著低于对照组(P < 0.05)；观察组肺部感染发生率为8.3%，显著低于对照组的25.0% (P < 0.05)；观察组：机械通气时间和ICU住院时间均短于对照组(P < 0.05)；观察组：美国国立卫生研究院卒中量表(NIHSS)评分改善程度优于对照组。结论：俯卧位联合呼吸训练能够有效改善脑出血合并肺功能低下患者的肺功能状态，降低肺部感染风险，缩短机械通气时间和ICU住院时间，促进神经功能恢复，具有良好的安全性，值得临床推广应用。

Abstract: Objective: To investigate the efficacy and safety of prone position ventilation combined with respiratory training in early rehabilitation for patients with intracerebral hemorrhage (ICH) complicated by pulmonary hypopnea. Methods: A prospective randomized controlled study was conducted. A total of 120 patients with ICH and pulmonary hypopnea admitted to the Neurosurgical Intensive Care Unit (ICU) from June 2022 to June 2025 were enrolled and randomly divided into an observation group and a control group (n = 60 each) using a random number table. The control group received conventional nursing care and basic respiratory training, while the observation group received prone position ventilation combined with systematic respiratory training in addition to conventional care. The pulmonary function indices, blood gas analysis parameters, incidence of pulmonary infections, mechanical ventilation duration, ICU hospitalization time, and neurological recovery were compared between the two groups before and after intervention. Results: After intervention, patients in the observation group showed significantly better values for forced vital capacity (FVC), first-second forced expiratory volume (FEV1), peak expiratory flow rate (PEF), and maximum inspiratory pressure (MIP) compared to the control group (P < 0.05). Arterial oxygen partial pressure (PaO₂) and oxygenation index (PaO₂/FiO₂) were markedly higher than those in the control group, while arterial carbon dioxide partial pressure (PaCO₂) was significantly lower (P < 0.05). The incidence of pulmonary infection in the observation group was 8.3%, significantly lower than the control group’s 25.0% (P < 0.05). Both mechanical ventilation duration and ICU hospitalization time were shorter in the observation group than in the control group (P < 0.05). National Institutes of Health Stroke Scale (NIHSS) scores was more pronounced in the observation group compared to the control group. Conclusion: Prone positioning combined with respiratory training can effectively improve pulmonary function in patients with cerebral hemorrhage and impaired lung function, reduce the risk of pulmonary infection, shorten mechanical ventilation duration and ICU hospitalization time, promote neurological recovery, and demonstrate good safety profiles, making it worthy of clinical application and promotion.