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目的 探讨呼吸训练加振动排痰的肺康复治疗对腹部手术后合并肺部感染患者的临床疗效.方法 采用回顾性病例对照研究方法,选择2015年9月至2016年9月在湖南师范大学第一附属医院接受腹部手术后出现肺部感染的患者共76例,根据是否进行肺康复治疗分为两组.对照组(35例)采用常规排痰方法;肺康复组(41例)在对照组基础上采用呼吸训练(有效咳嗽、缩唇呼吸)、呼吸训练器(三球仪)、机械辅助排痰等肺康复治疗.记录两组24h排痰量、舒适度、炎症和肺功能指标变化及恢复情况.结果 ①两组治疗前炎症及肺功能指标无明显差异.两组治疗后白细胞计数(WBC)和C-反应蛋白(CRP)均明显降低,1s用力呼气容积(FEV1)和FEV1/用力肺活量(FVC)比值明显升高,以肺康复组治疗效果更为显著[WBC(×109/L):3d为11.12±2.88比13.42±2.62,5d为8.22±1.48比9.27±1.92;CRP (mg/L):3 d为13.47±4.77比16.03±4.94,5d为9.69±1.56比11.77±1.41;FEV1(L):3 d为2.48±0.14比2.29±0.16;FEV1/FVC:3 d为0.78±0.04比0.75±0.04;均P＜0.05].②肺康复组治疗3d内24h排痰量均明显高于对照组(mL:1 d为30.51 ±4.15比18.30±3.64,2d为31.08±3.22比20.37±3.20,3d为29.03±2.55比19.03±2.51,均P＜0.01).③肺康复组患者肺部感染恢复时间(d:5.44±1.45比6.20± 1.55)、抗菌药物应用时间(d:12.61 ±3.15比15.03±3.78)、下床时间(d:4.05±0.74比4.51±0.89)及住院时间(d:19.95±3.90比22.00±4.42)均较对照组明显缩短(均P＜0.05);患者舒适度也明显优于对照组(分:2.71 ±0.90比2.14±0.91,P＜0.01).结论 以呼吸训练加振动排痰为主的肺康复治疗能促进腹部手术后合并肺部感染患者快速康复,具有较好的临床疗效及实际应用价值.“,”Objective To investigate the clinical effect of pulmonary rehabilitation therapy including respiratory exercise and vibration expectoration on patients with pulmonary infection after abdominal surgery.Methods A retrospective case control study was conducted.Seventy-six patients with pulmonary infection after abdominal surgery admitted to the First Affiliated Hospital of Hunan Normal University from September 2015 to September 2016 were enrolled.According to whether accept the pulmonary rehabilitation therapy or not,the patients were divided into two groups.In the control group (n =35),the convemional expectoration method was adopted.The patients in pulmonary rehabilitation group (n =41) received both methods of the control group and pulmonary rehabilitation treatment,including respiratory exercise (effective cough,lip reduction breathing),respiratory exercise device (respiratory exerciser tri-ball),and vibrated expectoration.The 24-hour sputum volume,degree of comfort,inflammatory and pulmonary function parameters,and recovery situation were recorded in the two groups.Results ① There were no significant differences in the parameters of inflammation and pulmonary function before treatment between the two groups.After treatment,the white blood cell (WBC) and C-reactive protein (CRP) in both groups were significantly decreased,and the forced expiratory volume in 1 second (FEV1) and FEV1/forced vital capacity (FVC) were significantly increased.The above changes in pulmonary rehabilitation group were more significant than those of the control group [WBC (× 109/L):11.12 ± 2.88 vs.13.42 ± 2.62 at 3 days,8.22 ± 1.48 vs.9.27 ± 1.92 at 5 days;CRP (mg/L):13.47 ± 4.77vs.16.03±4.94 at 3 days,9.69±1.56 vs.11.77±1.41 at 5 days;FEV1 (L):2.48±0.14 vs.2.29±0.16 at 3 days,FEV1/FVC:0.78±0.04 vs.0.75±0.04 at 3 days;all P ＜ 0.05].② The 24-hour sputum volume within 3 days of pulmonary rehabilitation group were significantly higher than that of the control group (mL:30.51 ± 4.15 vs.18.30 ± 3.64at 1 day,31.08±3.22 vs.20.37±3.20 at 2 days,29.03±2.55 vs.19.03±2.51 at 3 days,all P ＜ 0.01].③ In the pulmonary rehabilitation group,the recovery time of pulmonary infection symptoms (days:5.44 ± 1.45 vs.6.20 ± 1.55),the days of antibiotic use (days:12.61 ± 3.15 vs.15.03 ± 3.78),the time of getting out of the bed (days:4.05 ± 0.74vs.4.51±0.89),and the hospital days (days:19.95±3.90 vs.22.00±4.42) were significantly shorter than those of the control group (all P ＜ 0.05),and the degree of comfort was significantly better than that of the control group (comfort score:2.71 ±0.90 vs.2.14±0.91,P ＜ 0.01).Conclusion The application of pulmonary rehabilitation including respiratory exercise and vibration expectoration in abdominal surgery patients with pulmonary infection can promote recovery,and it has a good clinical and practical application value.