物联网呼吸康复在社区获得性肺炎患者中的应用

谢亚静; 陈乐; 王立亚; 张金佳; 赵稳稳; 叶丽云; 王荣英

doi:10.16766/j.cnki.issn.1674-4152.004132

物联网呼吸康复在社区获得性肺炎患者中的应用

doi: 10.16766/j.cnki.issn.1674-4152.004132

1.
河北医科大学第二医院全科医疗科，河北石家庄 050000
2.
河北医科大学第二医院呼吸与危重症一科

基金项目:

河北省医学适用技术跟踪项目 GZ20250091

详细信息

通讯作者:
王荣英，E-mail: wangrongying@hebmu.edu.cn

中图分类号: R563.1
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- 文章访问数: 9
- HTML全文浏览量: 4
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- 被引次数: 0
出版历程
- 收稿日期: 2025-03-31
- 网络出版日期: 2025-10-31

Application of IoT-based respiratory rehabilitation in patients with community-acquired pneumonia

1.
Department of General Practice, the Second Hospital of Hebei Medical University, Shijiazhuang, Hebei 050000, China

摘要

摘要: 目的探讨基于物联网技术的呼吸康复训练对社区获得性肺炎患者临床症状、肺功能及实验室检查的影响。方法选取2023年7月—2024年12月就诊于河北省某三甲医院诊断为社区获得性肺炎的176例患者为研究对象，根据随机数字表法分为试验组和对照组，每组88例。对照组实施常规治疗和护理，试验组在对照组的基础上应用呼吸训练器进行呼吸训练。分别于干预前、干预7 d后、干预14 d后对2组患者的生理指标、临床症状、实验室检查、胸部CT平扫、肺功能、是否发生不良事件进行比较。结果干预7 d后，试验组C反应蛋白[6.00(3.00, 11.00)mg/L vs. 6.00(5.00, 15.00)mg/L]、降钙素原[0.03(0.02, 0.05)ng/mL vs. 0.03(0.02, 0.08)ng/mL]、第1秒用力呼气容积[FEV₁，2.56(1.96, 3.20)L vs. 2.23(1.03, 2.78)L]、最大吸气压[MIP，50(36, 71)cmH₂O vs. 41(32, 64)cmH₂O，1 cmH₂O=0.098 kPa]、咳嗽程度评分[CET，7(7, 8)分vs. 10(9, 11)分]均优于对照组(P < 0.05)。干预14 d后试验组FEV₁[2.83(2.15, 3.44)L vs. 2.59(1.84, 3.14)L]、用力呼气肺总量[FVC，4.10(3.28, 5.02)L vs. 3.17(2.38, 4.06)L]、MIP[64(52, 78)cmH₂O vs. 60(46, 72)cmH₂O]、最大呼气压[MEP，88(76, 117)cmH₂O vs. 80(62, 108)cmH₂O]均优于对照组(P < 0.05)。干预期间，2组患者均无不良事件发生。结论基于物联网技术的呼吸康复训练对社区获得性肺炎患者改善临床症状、提高肺功能具有积极作用。
- 社区获得性肺炎 /
- 物联网 /
- 呼吸康复 /
- 呼吸训练
Abstract: Objective To investigate the effects of Internet of Things (IoT)-based respiratory rehabilitation training on clinical symptoms, pulmonary function, and laboratory parameters in patients with community-acquired pneumonia (CAP). Methods A total of 176 CAP patients admitted to a Level A Tertiary hospital in Hebei Province between July 2023 and December 2024 were enrolled in the study, and assigned to either an experimental group (n=88) or a control group (n=88) using a random number table method. The two groups received standard medical care; however, the experimental group also additionally underwent IoT-based respiratory training with a portable breathing device. A comprehensive evaluation of the clinical outcomes was conducted, encompassing various parameters, such as physiological indicators, the severity of symptoms, laboratory markers, imaging findings, pulmonary function and nutritional status. These outcomes were assessed at three distinct time points: baseline, 7 days post-intervention, and 14 days post-intervention. Results At the 7-day follow-up, the experimental group exhibited significant improvements compared to controls in CRP reduction [6.00 (3.00, 11.00) mg/L vs. 6.00 (5.00, 15.00) mg/L], PCT normalization [0.03 (0.02, 0.05) ng/mL vs. 0.03 (0.02, 0.08) ng/mL], forced expiratory volume in the first second [FEV₁, 2.56 (1.96, 3.20) L vs. 2.23 (1.03, 2.78) L], maximum inspiratory pressure [MIP, 50 (36, 71) cmH₂O vs. 41 (32, 64) cmH₂O, 1 cmH₂O=0.098 kPa], and cough severity scores [7 (7, 8) vs. 10 (9, 11), P < 0.05]. By day 14, further enhancements were observed in FEV₁ [2.83 (2.15, 3.44) L vs. 2.59 (1.84, 3.14) L], forced vital capacity [FVC, 4.10 (3.28, 5.02) L vs. 3.17 (2.38, 4.06) L], MIP [64 (52, 78) cmH₂O vs. 60 (46, 72) cmH₂O], maximum expiratory pressure [MEP, 88 (76, 117) cmH₂O vs. 80 (62, 108) cmH₂O] with all comparisons showing statistical significance (P < 0.05). During the intervention period, no adverse reactions occurred in either the experimental group or the control group. Conclusion The findings of this study demonstrate that IoT-facilitated respiratory rehabilitation effectively alleviates systemic inflammation, improves pulmonary mechanics, and accelerates clinical recovery in CAP patients.
- Community-acquired pneumonia /
- Internet of things /
- Respiratory rehabilitation /
- Respiratory training

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表 1 呼吸训练方案

Table 1. Respiratory training program

阶段(干预时间: 地点)	具体内容	方式(频次)
在院(7 d: 病房)	1.干预前行简易肺功能测定	护士床旁监督指导完成(2次/d，每次时间约15~20 min)
	2.每次训练包括吸气训练、呼气训练，痰液较多或痰液不易咳出者加做气道廓清训练
	3.吸气训练和呼气训练的难度设置均采用自动模式，从一档开始训练，前三次吸气/呼气无阻力，第四次开始系统自动增加阻力，阻力增加的大小随难度挡位的增加而递增; 训练次数设置以患者稍感费力但不疲劳为宜
	4.气道廓清采用手动模式，训练阻力设置一般由高到低，咳嗽频繁或剧烈可适当降低阻力; 呼吸训练器固有频率设置可依据患者训练时的自主频率而变化，固有频率与患者自主频率相同时排痰效果最好; 每次排痰前需要在深吸气后屏气2~3 s
	5.7 d结束时行简易肺功能测定
院外(7 d: 居家)	1.按出院时的各项参数继续训练，训练期间可根据疾病恢复情况调整训练参数	居家自行训练(2次/d，每次约15~20 min)
	2.护士每日下午下班前调取患者数据并记录
	3.单项训练次数少于住院时训练次数或训练成绩明显低于住院时成绩的，护士微信或电话随访原因并指导
	4.训练结束时行简易肺功能测定

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表 2 2组CAP患者一般资料比较

Table 2. Comparison of general data betwen two groups of CAP patients

组别	例数	年龄 (x±s，岁)	性别(例)		吸烟史(例)^c		BMI [M(P₂₅, P₇₅)]	慢病种类 [M(P₂₅, P₇₅)，种]
组别	例数	年龄 (x±s，岁)	男性	女性	是	否	BMI [M(P₂₅, P₇₅)]	慢病种类 [M(P₂₅, P₇₅)，种]
试验组	88	56.60±11.71	49	39	35	53	23.9(21.7, 25.0)	1(0, 1)
对照组	88	55.40±10.81	50	38	23	26	23.7(21.9, 25.0)	1(0, 1)
统计量		0.706^a	0.023^b		3.703^b		-0.491^d	-0.700^d
P值		0.481	0.879		0.054		0.623	0.484
注: ^a为t值，^b为χ²值，^d为Z值; ^c代表一生中连续或累积吸烟6个月及以上者定义为有吸烟史。

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表 3 干预前及干预7 d后2组CAP患者生理指标、实验室检查、影像学、临床症状比较[M(P₂₅, P₇₅)]

Table 3. Comparison of physiological indicators, laboratory tests, imaging, and clinical symptoms of CAP patients between the two groups before intervention and 7 days after intervention[M(P₂₅, P₇₅)]

项目	时间	试验组(n=88)	对照组(n=88)	Z值	P值
呼吸频率(次/min)	干预前	21(20, 22)	21(20, 22)	-0.750	0.453
	干预后	19(18, 20)^a	19(18, 20)^a	-1.891	0.059
脉率(次/min)	干预前	92(80, 97)	92(80, 96)	-0.656	0.512
	干预后	78(75, 80)^a	78(72, 80)^a	-0.841	0.401
末梢血氧饱和度(%)	干预前	92(92, 93)	93(92, 93)	-1.031	0.302
	干预后	96(95, 97)^a	96(95, 97)^a	-0.437	0.662
WBC(×10⁹/L)	干预前	9.53(7.52, 12.14)	9.00(7.19, 13.37)	-0.425	0.671
	干预后	8.06(7.59, 9.07)^a	7.93(7.06, 8.79)^a	-1.919	0.055
CRP(mg/L)	干预前	25.50(13.50, 66.00)	18.00(9.50, 60.50)	-1.002	0.316
	干预后	6.00(3.00, 11.00)^a	6.00(5.00, 15.00)^a	-1.966	0.046
PCT(ng/mL)	干预前	0.06(0.03，0.09)	0.03(0.04, 0.09)	-1.658	0.097
	干预后	0.03(0.02，0.05)^a	0.03(0.02，0.08)^a	-2.072	0.038
影像学	干预后	2(1, 2)	2(1, 2)	-0.106	0.915
mMRC(分)	干预前	1(0, 2)	1(0, 2)	-0.852	0.394
	干预后	0(0, 1)^a	0(0, 1)^a	-1.840	0.066
CET(分)	干预前	13(11, 18)	15(14, 16)	-0.202	0.840
	干预后	7(7, 8)^a	10(9, 11)^a	-10.807	＜0.001
注: 与同组干预前比较，^aP＜0.05;影像学结果1代表好转，2代表无变化。

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表 4 干预前及干预7 d后2组CAP患者肺功能检查比较[M(P₂₅, P₇₅)]

Table 4. Comparison of pulmonary function tests between the two groups of CAP patients before intervention and 7 days after intervention[M(P₂₅, P₇₅)]

项目	时间	试验组(n=88)	对照组(n=88)	Z值	P值
FEV₁(L)	干预前	2.13(1.43, 2.67)	2.02(0.92, 2.64)	-1.697	0.090
	干预后	2.56(1.96, 3.20)^a	2.23(1.03, 2.78)^a	-2.007	0.045
FVC(L)	干预前	2.79(2.36, 3.86)	2.80(1.33, 3.72)	-1.266	0.205
	干预后	3.35(2.52, 4.04)^a	3.08(1.61, 3.90)^a	-1.212	0.226
MIP(cmH₂O)	干预前	42(24, 49)	30(23, 46)	-1.845	0.065
	干预后	50(36, 71)^a	41(32, 64)^a	-2.345	0.019
MEP(cmH₂O)	干预前	69(53, 100)	69(53, 100)	-0.742	0.458
	干预后	82(59, 117)^a	76(55, 96)^a	-1.385	0.166
PIF(L/min)	干预前	193(169, 225)	194(173, 233)	-0.324	0.746
	干预后	285(256, 334)^a	276(225, 327)^a	-1.203	0.229
PEF(L/min)	干预前	349(268, 488)	360(253, 517)	-0.394	0.694
	干预后	356(262, 538)^a	376(256, 538)^a	-0.118	0.906
注: 与同组干预前比较，^aP＜0.05。1 cmH₂O=0.098 kPa。

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表 5 干预前及干预14 d后2组CAP患者生理指标、实验室检查、影像学、临床症状比较[M(P₂₅, P₇₅)]

Table 5. Comparison of physiological indicators, laboratory tests, imaging, and clinical symptoms of CAP patients between the two groups before intervention and 14 days after intervention[M(P₂₅, P₇₅)]

项目	时间	试验组(n=82)	对照组(n=84)	Z值	P值
呼吸频率(次/min)	干预前	21(20, 22)	21(20, 22)	-0.750	0.453
	干预后	19(18, 20)	19(18, 20)	-1.014	0.310
脉率(次/min)	干预前	92(80, 97)	92(80, 96)	-0.656	0.512
	干预后	75(72, 76)	75(68, 76)	-0.772	0.440
末梢血氧饱和度(%)	干预前	92(92, 93)	93(92, 93)	-1.031	0.302
	干预后	96(96, 97)	96(96, 97)	-0.205	0.838
WBC(×10⁹/L)	干预前	9.53(7.52, 12.14)	9.00(7.19, 13.37)	-0.425	0.671
	干预后	7.62(7.05, 8.24)	6.39(5.80, 7.05)	-3.397	0.061
CRP(mg/L)	干预前	25.50(13.50, 66.00)	18.00(9.50, 60.50)	-1.002	0.316
	干预后	6.50(5.00, 8.00)	7.00(5.00, 8.00)	-0.925	0.355
影像学	干预后	1(1, 1)	1(1, 1)	< 0.001	0.999
mMRC(分)	干预前	1(0, 2)	1(0, 2)	-0.852	0.394
	干预后	0(0, 1)	0(0, 1)	-1.275	0.202
CET(分)	干预前	13(11, 18)	15(14, 16)	-0.202	0.840
	干预后	7(7, 8)	8(7, 9)	-1.106	0.281
注: 影像学1代表好转，2代表无变化。

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表 6 干预前及干预14 d后2组CAP患者肺功能检查比较[M(P₂₅, P₇₅)]

Table 6. Comparison of pulmonary function tests between the two groups of CAP patients before intervention and 14 days after intervention[M(P₂₅, P₇₅)]

项目		试验组(n=82)	对照组(n=84)	Z值	P值
FEV₁(L)	干预前	2.10(1.43, 2.67)	2.02(0.92, 2.64)	-1.697	0.090
	干预后	2.83(2.15, 3.44)^a	2.59(1.84, 3.14)^a	-2.540	0.011
FVC(L)	干预前	2.79(2.36, 3.86)	2.80(1.33, 3.72)	-1.266	0.205
	干预后	4.10(3.28, 5.02)^a	3.17(2.38, 4.06)^a	-4.913	＜0.001
MIP(cmH₂O)	干预前	42(24, 49)	30(23, 46)	-1.845	0.065
	干预后	64(52, 78)^a	60(46, 72)^a	-1.963	0.046
MEP(cmH₂O)	干预前	69(53, 100)	69(53, 100)	-0.884	0.377
	干预后	88(76, 117)^a	80(62, 108)^a	-2.058	0.040
PIF(L/min)	干预前	195(169, 229)	195(165, 231)	-0.120	0.905
	干预后	284(240, 333)^a	291(236, 339)^a	-0.491	0.623
PEF(L/min)	干预前	349(274, 502)	373(287, 517)	-1.021	0.307
	干预后	382(278, 538)^a	379(278, 508)^a	-0.005	0.996
注: 与同组干预前比较，^aP＜0.05。

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