| Research backgroundChronic obstructive pulmonary disease(COPD)is a systemic chronic disease,which seriously affects the ability and quality of life of the patients.It brings great economic burden to the society and family,and brings serious psycho logical burden to the patients and their families.According to research reports,COPD is currently ranked fourth in the global cause of death.It is predicted that by 2020,it will rise to third,and the economic burden on society and family is the fifth largest,the chronic disease report in China mentioned that COPD is the main cause of the loss of quality of life in patients.The physical condition of patients with acute exacerbation of COPD is worse than that of patients in stable stage,with severe loss of motor function and severely reduced quality of life.Obvious difficulty in breathing may occur immediately during slight activity;breathing work is increased during respiratory function exercise,and patients with acute exacerbation are prone to develop breath Muscle fatigue is more difficult to implement in patients with poor endurance,and pulmonary function,exercise capacity,etc.,recover slowly after acute exacerbation.Therefore,for patients with acute exacerbation of COPD,regular exercise training or respiratory exercise is difficult to implement and adhere to,seriously affecting the compliance and efficacy of pulmonary rehabilitation At present,the focus of the study on acute exacerbation of chronic obstructive pulmonary disease(AECOPD)in the Chinese mainland focuses on the treatment of heart and lung failure in patients with acute exacerbations.Pulmonary rehabilitation studies in patients with acute exacerbations of COPD have been rare.Also,studies have shown that the sooner lung regenerationis performed after an acute attack of COPD,the better.Therefore,for patients with acute exacerbation of COPD,how to accelerate their recovery,improve the quality of life of patients,while ensuring the safety of patients and improving the compliance of long-term rehabilitation treatment in the future,has become a focus of attention today.In todays medical situation,this is also the biggest challenge for our care.It is very important to explore a suitable pulmonary rehabilitation method for this type of patients.ObjectiveTo investigate the effect of pacemakers in vitro on pulmonary rehabilitation in patients with acute exacerbation of chronic obstructive pulmonary disease,in order to accelerate the patient's pulmonary rehabilitation;shorten the hospitalization date,speed up the turnover,reduce medical costs;reduce the symptoms of dyspnea and improve the quality of life of patients.Research objects and methods1)estimation of sample sizeThis study is a retrospective study.In the observation group,in vitro combined with in vitro diaphragmatic muscle pacing,that is,COPD acute exacerbation period and stable phase were combined with in vitro diaphragmatic muscle pacing;the control group was only in the disease stable stage combined with in vitro diaphragm muscle pacing.Strict compliance with inclusion and exclusion criteria,and the COPD score as the main observation index.Combined with previous literature reports and pre-collection of case results,it was estimated that the decline in CAT scores in the observation and control groups was 6.0 and 3.5,respectively.Let ? =0.05,power = 0.90.Applying People's Medical Publishing House 3rd Edition"Medical Statistics" sample size estimation method to calculate,we can see that if we want to draw a difference conclusion,32 patients need to be enrolled in each group.research methodsA total of 70 patients who were hospitalized in the Department of Respiratory Medicine of the First People's Hospital of Shunde District from February 2015 to September 2016 for the acute exacerbation of chronic obstructive pulmonary disease were selected as study subjects and included in the criteria:in line with the 2013 Chinese Medical Association's Respiratory Diseases Criteria for the diagnosis and treatment of chronic obstructive pulmonary diseases established by the club;acute exacerbations(acute exacerbations)were diagnosed according to the standard of AECOPD in the 2013 revision of the COPD diagnosis and treatment guidelines of the Respiratory Society of the Chinese Medical Association;patients were still present at stable stage.Cough and asthma,but the symptoms have stabilized,no acute exacerbations.Exclusion criteria:patients and their family members could not understand and could not cope with the investigators;patients who had participated in other treatments within the last month;excluded pacemakers,active tuberculosis,Patients with peumothorax;Severe adverse reactions during the study process,leading to treatment interruption of patients;During the course of treatment,the patients condition changes,leading to treatment interruption of patients;incomplete data affect the outcome judge;In the course of the study,the patient himself refused to continue to participate in the study,resulting in treatment interruption.In this study,a retrospective study was conducted.In February 2015,the department used an external diaphragmatic pacemaker to treat COPD stable patients.Until December 2015,the timing of the use of pacemakers in vitro was extended from stable to acute exacerbations..Thirty-five patients who were hospitalized for acute exacerbation of chronic obstructive pulmonary disease from February to November 2015 were treated as the control group before and after the hospitalization and treatment status;due to chronic obstructive pulmonary disease from December 2015 to September 2016.Thirty-five patients with acute exacerbations were treated as observation groups.Both groups of patients received reasonable drug treatment and nursing routines during hospitalization Patients in the control group were only treated with a pacemaker in vitro at a stable stage.Patients in the observation group began to use an in vitro diaphragmatic pacemaker in an acute exacerbation period.In the acute exacerbation period and stable period of COPD,an in vitro diaphragmatic pacemaker was used in combination.To compare the lung rehabilitation compliance,health-related quality of life scores,dyspnea scores,length of stay,comfort,and adverse reactions between the two groups of patients during acute exacerbation,and to observe whether the two groups of patients had statistical significance.ResultIn this study,the compliance of the two groups of patients with lung rehabilitation was investigated and analyzed.In the acute exacerbation period,the routine lung rehabilitation exercise was adhered to,that is,to adhere to the lip-abdominal breathing exercise or tower limb function exercise,and to adhere to two times a day,10-15 minutes each time.control group patients with good compliance for 7 cases(21.9%),observation group of patients with good compliance for 6 cases(17.6%),the compliance of the patients in the two groups was not statistically significant,And the compliance of the two groups was low.The survey found that the main reason of acute attack period cannot adhere to the pulmonary rehabilitation were decreased exercise tolerance(68.2%);staff ignored and no guide(68.2%)for patients The patient has a great psychological stress and fears that lung recovery will aggravate the degree of dyspnea or cause difficulty in breathing(57.6%);The patients' awareness of lung rehabilitation was insufficient,and it was considered that the lung rehabilitation was not required(10%)when the acute attack.In this study,the patients in the observation group CAT score at discharge,dyspnea score and hospitalization time were lower than the control group,the control group of patients with CAT score 30.210 + 3.949,3.030 + 0.694 degree of dyspnea score,hospitalization time was 10.090 + 1.784d;the patients in the observation group CAT score was 27.79 + 2.897,degree of dyspnea score was 2.41+ 0.608 and the hospitalization time was 9.14 + 1.351d,there was significant difference between two groups(P<0.05).In the short term,it can improve the patient's breathing difficulty,improve the quality of life and shorten the time of hospitalization.In this study,no adverse reaction occurred in the use of the instrument,two groups of patients with external diaphragm pacing therapy,in strict accordance with operation process execution,the external diaphragm Bo two groups during the treatment,the control group heart rate decreased in 7 cases(21.2%),blood pressure decreased in 3 cases(9.4%);the observation group decreased heart rate in 9 cases(26.5%),the blood pressure decreased in 5 cases(14.7%),the patients complained no discomfort.There was no significant difference in heart rate and blood pressure drop in the two groups of patients with adverse reactions.In the observation group,2 patients complained of palpitations.But in this study,some patients have different levels of heart rate and blood pressure.In the course of treatment,whether the heart rate is too fast or other causes may cause accident or even sudden death.There is no reference to the indications and contraindications of the use of the instrument,and there are no related reports in previous studies.Therefore,the safety of the use of the extracorporeal diaphragm pacemaker and the long-term effectiveness still remain to be further studied.Conclusion(1)Starting the use of in vitro diaphragm pacemaker treatment during the COPD acute booster period can improve the patient's respratory distress,improve the quality of life,and shorten the length of hospitalization.In today's medical treatment,the rapid rehabilitation of critically ill patients is the direction and focus of future care.In this study,the timing of lung rehabilitation interventions has expanded from stable to acute aggravation.The focus of nursing work has shifted from focusing on the coordination of cardiopulmonary failure treatment in patients with acute aggravation to focusing cm lung rehabilitation at the same time.On the basis of the use of drug therapy,the treatment of the external diaphragm pacemaker during the acute booster phase of COPD is effective.It can relieve diaphragm fatigue,strengthen diaphragm endurance,improve breathing difficulties,improve the quality of life,and shorten the time for hospitalization.It has certain clinical feasibility and is worth popularizing in clinical application.(2)During the treatment of patients with COPD,different degrees of heart rate and blood pressure changes occurred,and the safety of the use needs to be further studied and improved.In vitro,the use of diaphragm pacemakers is relatively extensive and the technology is relatively mature.However,in this study,some patients showed varying degrees of heart rate and blood pressure.During the treatment process,whether the heart rate dropped too fast or other reasons caused the patient to have accidents.,Even sudden death.There is no mention in the instructions for the use of the instrument,and there is no related report in previous studies.Therefore,the safety of the use of the diaphragm in vitro needs to be further studied and improved. |
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