Study On The Effect Of Oscillatory Positive Pressure Expiratory Training In Pulmonary Rehabilitation Of Patients With Acute Exacerbation Of Chronic Obstructive Pulmonary Disease

ObjectiveTo investigate the effects of Oscillatory positive pressure expiratory training on blood gas analysis,lung function indicators,exercise endurance,sputum excretion effect and length of hospital stay in patients with acute exacerbation of chronic obstructive pulmonary disease（AECOPD）after extubation.MethodsIn this study,126 patients with AECOPD who were extubated after mechanical ventilation treatment in the Respiratory Intensive Care Unit（RICU）of Changzhou Second People’s Hospital from January 2018 to January 2019 were selected as the study subjects,According to the random number table method,the patients were divided into the experimental group（63 cases）and the control group（63 cases）.During the study,4 cases were intubated again in the experimental group and 4 cases were intubated again in the control group,all of which were excluded.Finally,59cases were in the experimental group and 59 cases in the control group.In the control group,lip contraction breathing,abdominal breathing and effective cough were used for pulmonary rehabilitation training.In the experimental group,on the basis of lip contraction breathing,abdominal breathing and effective cough training in the control group,positive pressure ventilation equipment Acapella?Duet was used for pulmonary rehabilitation training.Both groups completed 28d pulmonary rehabilitation training.Arterial partial carbon dioxide pressure（Pa CO₂）,arterial partial oxygen pressure（Pa O₂）,pulmonary function（FVC,FEV1,FEV1/FVC,MMEF,MEF）,6-min walk distance（6MWD）,average daily spume excretion,and length of hospital stay were compared between the two groups before training,3d training,6d training,and 28d training.Results1、Blood Gas Analysis:during 3d training,there was no statistically significant difference between the two groups in arterial blood Pa CO₂and Pa O₂（P>0.05）;At 6days of training,the arterial blood Pa CO₂in the experimental group was lower than that in the control group（73.37±10.62,77.52±10.31）,and Pa O₂was higher than that in the control group（72.58±8.71,68.62±8.65）,with statistically significant differences（P<0.05）.After 28 days of training,the arterial blood Pa CO₂in the experimental group was lower than that in the control group（67.15±8.02,72.11±9.16）,and Pa O₂was higher than that in the control group（74.52±8.12,69.42±8.22）,with statistically significant differences（P<0.05）.There was no significant difference in p H between the two groups before and after training（P>0.05）.2、Lung Function:there was no statistically significant difference in FVC,FEV1,and FEV1/FVC between the two groups on 3 and 6 days of training（P>0.05）.After 28days of training,FVC:experimental group and control group（2.44±0.31 vs2.31±0.30,P<0.05）,FEV1:experimental group and control group（1.34±0.34 vs1.21±0.30,P<0.05）,FEV1/FVC:experimental group and control group（57.12±6.67 vs54.83±6.22,P<0.05）.The MMEF and MEF of the experimental group were significantly different from those of the control group on 3d,6d and 28d（P<0.05）.3、Six-min Walk Distance:Compared with the control group at 3d（207.83±23.01）,6d（228.35±25.57）and 28d（240.91±33.17）,the experimental group had higher training distance at 3d（195.14±22.36）,6d（211.66±26.81）and 28d（219.06±30.43）,with statistically significant differences（P<0.05）.4、Average Daily Sputum Discharge:The average daily sputum discharge in the experimental group was higher than that in the control group（19.58±3.05,12.24±2.16）on the first 3 days after training,and the difference was statistically significant.（P<0.05）.However,there was no statistically significant difference between the two groups in the average daily sputum excretion during hospitalization（P>0.05）.5、Length of Hospital Stay:The length of hospital stay in the experimental group was shorter than that in the control group（13.02±1.01,14.15±2.06）,the difference was statistically significant（P<0.05）.ConclusionOscillatory positive pressure expiratory training can effectively reduce Pa CO₂of AECOPD patients,improve Pa O₂level,improve exercise endurance,promote sputum excretion,and shorten the length of hospital stay of AECOPD patients.