早期肺康复对重症和危重症COVID-19患者的疗效：一项回顾性队列研究。

Efficacy of early pulmonary rehabilitation in severe and critically ill COVID-19 patients: a retrospective cohort study.

作者信息

Wang Xue, Ma Haomiao, He Xiaoya, Gu Xiaomeng, Ren Yi, Yang Huqin, Tong Zhaohui

机构信息

Department of Respiratory and Critical Care Medicine, Beijing Institute of Respiratory Medicine and Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China.

Sports and Medicine Integrative Innovation Center, Capital University of Physical Education and Sports, Beijing, China.

出版信息

BMC Pulm Med. 2025 Apr 29;25(1):203. doi: 10.1186/s12890-025-03678-x.

DOI:10.1186/s12890-025-03678-x

PMID:40301769

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC12039096/

Abstract

BACKGROUND

Respiratory sequelae, induced by lung injury, reduced muscle strength, and nutritional disturbance, are common in hospitalized patients with coronavirus disease 2019 (COVID-19). Therefore, optimal treatment is essential for reducing the mortality in severe forms of the disease and critically ill patients. Pulmonary rehabilitation (PR) has been used in many chronic respiratory diseases, but the role of early PR in severe and critically ill COVID-19 patients remains to be fully understood.

METHODS

Hospitalized severe to critically ill COVID-19 patients were recruited from Beijing Chaoyang Hospital between December 1, 2022, and June 30, 2023. In all, we recruited 272 patients, with 39 in the PR group and 233 in the control group. The PR intervention consisted of the prone position, airway clearance therapy (ACT), and resistance respiratory training (RRT). The primary outcome was the composite disease progression outcome rate, defined as death or intensive care unit (ICU) admission. Adverse events (AEs) and serious adverse events (SAEs) were recorded in the PR group. Inverse probability of treatment weighting (IPTW) and propensity score matching (PSM) was used to balance confounding bias, generating weighting cohort and matched cohort.

RESULTS

The rate of the primary outcome was lower in the PR group (28.2% [11/39] in the PR group vs. 48.9% [114/233] in the control group). Significant differences were observed in both the original and weighting cohorts. Subgroup analyses showed that receiving ≥ 2 types of PR, receiving RRT, length from admission to intervention ≤ 4 days, and baseline P/F ≤ 150 mmHg were associated with lower rates of progression. Total rates of 2.6% (1/39) for AEs and 10.26% (4/39) for SAEs were reported.

CONCLUSIONS

Early pulmonary rehabilitation may prevent disease progression and reduce mortality in patients with severe COVID-19. These findings may be helpful for formulating an optimal rehabilitation strategy.

摘要

背景

由肺损伤、肌肉力量下降和营养紊乱引起的呼吸后遗症在2019冠状病毒病（COVID-19）住院患者中很常见。因此，最佳治疗对于降低该疾病严重形式和危重症患者的死亡率至关重要。肺康复（PR）已用于许多慢性呼吸道疾病，但早期PR在重症和危重症COVID-19患者中的作用仍有待充分了解。

方法

2022年12月1日至2023年6月30日期间，从北京朝阳医院招募住院的重症至危重症COVID-19患者。我们共招募了272名患者，其中PR组39名，对照组233名。PR干预包括俯卧位、气道清理治疗（ACT）和阻力呼吸训练（RRT）。主要结局是综合疾病进展结局率，定义为死亡或入住重症监护病房（ICU）。记录PR组的不良事件（AE）和严重不良事件（SAE）。采用治疗权重逆概率（IPTW）和倾向评分匹配（PSM）来平衡混杂偏倚，生成加权队列和匹配队列。

结果

PR组的主要结局率较低（PR组为28.2%[11/39]，对照组为48.9%[114/233]）。在原始队列和加权队列中均观察到显著差异。亚组分析表明，接受≥2种类型的PR、接受RRT、入院至干预时间≤4天以及基线P/F≤150 mmHg与较低的进展率相关。报告的AE总发生率为2.6%（1/39），SAE总发生率为10.26%（4/39）。