摘要目的:探讨气管切开非机械通气患者在集束化气道管理的基础上行早期肺康复训练的临床应用效果。方法:采用便利抽样法，选取2022年1月至2023年5月于山西省汾阳医院行气管切开术非机械通气的成人患者，并根据入院时间将患者分为对照组和观察组。对照组在《气管切开非机械通气患者气道护理》的基础上实施集束化气道管理；观察组在集束化气道管理的基础上增加肺康复训练，由专门的呼吸康复小组成员实施。主要评价指标为患者住院时间、肌力等级提高率、膈肌移动度、气管套管拔管成功率；次要评价指标为患者肺部感染率、生活自理能力提高率、拔管患者套管留置时长。结果:最终对照组纳入41例患者，观察组纳入39例患者。两组性别、年龄、疾病第一诊断、入院日常生活能力量表（ADL）评分差异均无统计学意义，说明基线资料均衡，具有可比性。与对照组比较，观察组住院时间明显缩短（d：38.33±17.58比51.34±27.06），肌力等级提高率明显升高（76.92%比39.02%），膈肌移动度明显增加（cm：1.86±0.64比1.44±0.57），拔管成功率明显提高（38.46%比17.07%），成功拔管患者套管留置时长明显缩短（d：33.26±17.87比50.60±21.98），差异均有统计学意义（均 P<0.05）。观察组ADL评分提高率（56.41%比36.59%）和肺部感染率（5.13%比7.32%）虽优于对照组，但差异无统计学意义（均 P>0.05）。 结论:在实施集束化气道管理基础上增加肺康复训练能够提高气管切开非机械通气患者的活动耐力，改善呼吸功能，促进痰液清除，有利于提高拔管成功率，缩短住院时间，促进患者早日康复。

abstractsObjective:To explore the clinical application effects of early pulmonary rehabilitation training based on bundle airway management in patients with tracheostomy and non-mechanical ventilation.Methods:Used convenience sampling, adult patients who underwent tracheostomy and non-mechanical ventilation admitted to Fenyang Hospital of Shanxi Province from January 2022 to May 2023 were enrolled. Patients were divided into control group and observation group based on their admission dates. The control group implemented bundle airway management based on the Airway care for patients with tracheostomy and non- mechanical ventilation. The observation group received additional pulmonary rehabilitation training implemented by a specialized respiratory rehabilitation team. The primary outcomes included hospital stay duration, improvement rate of muscle strength, diaphragmatic mobility, and successful extubation rate. Secondary outcomes included the incidence of pulmonary infection, improvement rate of self-care ability, and the duration of tracheal tube placement in extubated patients. Results:A total of 41 patients were included in the control group and 39 patients in the observation group. There were no significantly differences in gender, age, first diagnosis of disease, and activities of daily living (ADL) score at admission between the two groups, indicating balanced baseline data and comparability. Compared with the control group, the observation group had a significantly shorter hospital stay (days: 38.33±17.58 vs. 51.34±27.06), a higher improvement rate of muscle strength (76.92% vs. 39.02%), greater diaphragmatic mobility (cm: 1.86±0.64 vs. 1.44±0.57), and a higher success rate of tracheostomy tube extubation (38.46% vs. 17.07%), the duration of tracheal tube placement in successfully extubated patients was significantly reduced (days: 33.26±17.87 vs. 50.60±21.98), with all differences being statistically significant (all P < 0.05). Although the improvement rate of ADL score (56.41% vs. 36.59%) and the incidence of pulmonary infection (5.13% vs. 7.32%) in the observation group were better than those in the control group, but there were no differences (both P > 0.05). Conclusion:The addition of pulmonary rehabilitation training in bundle airway management can enhance exercise tolerance, improve respiratory function, promote sputum clearance, increase successful extubation rates, shorten hospital stays, and facilitate early recovery in patients with tracheostomy and non-mechanical ventilation.