ISSN 2097-6046（网络）
ISSN 2096-7446（印刷）
CN 10-1655/R
主管：中国科学技术协会
主办：中华护理学会
中华急危重症护理杂志

中华急危重症护理杂志 ›› 2026, Vol. 7 ›› Issue (5): 532-539.doi: 10.3761/j.issn.2096-7446.2026.05.003

• 论著 • 上一篇    下一篇

体外循环心脏手术患者术后早期呼吸康复管理方案的构建及适用性分析

李尊柱1(), 常晓未1, 曹倩倩1, 赵明曦1, 罗红波1, 井杰1, 孙建华2, 兰元梅3, 吴欣娟3,*()   

  1. 1 中国医学科学院北京协和医学院 北京协和医院重症医学科 北京协和医院重症医学科 北京市 100730
    2 中国医学科学院北京协和医学院 北京协和医院内科ICU 北京协和医院内科ICU 北京市 100730
    3 中国医学科学院北京协和医学院 北京协和医院护理部 北京协和医院护理部 北京市 100730
  • 收稿日期:2025-10-04 出版日期:2026-05-10 发布日期:2026-04-28
  • 通讯作者: *吴欣娟，E-mail：wuxinjuan@sina.com
  • 作者简介:李尊柱：男，本科（硕士在读），主任护师，护士长，E-mail：1967786931@qq.com
    第一联系人：

    李尊柱、常晓未：研究设计、文献检索、论文撰写；曹倩倩：数据整理、统计学分析；赵明曦、罗红波、井杰、孙建华、兰元梅：论文修改；吴欣娟：研究指导、论文修改

  • 基金资助:
    国家重点研发计划重点专项项目(2022YFC2504505)

The construction and applicability analysis of a respiratory rehabilitation management program for the early postoperative period in patients undergoing cardiopulmonary bypass cardiac surgery

LI Zunzhu1(), CHANG Xiaowei1, CAO Qianqian1, ZHAO Mingxi1, LUO Hongbo1, JING Jie1, SUN Jianhua2, LAN Yuanmei3, WU Xinjuan3,*()   

  1. 1 Department of Critical Care Medicine， Peking Union Medical College Hospital，Chinese Academy of Medical Sciences & Peking Union Medical College， Beijing 100730， China
    2 Department of Internal Medicine Intensive Care Unit， Peking Union Medical College Hospital，Chinese Academy of Medical Sciences & Peking Union Medical College， Beijing 100730， China
    3 Department of Nursing， Peking Union Medical College Hospital，Chinese Academy of Medical Sciences & Peking Union Medical College， Beijing 100730， China
  • Received:2025-10-04 Online:2026-05-10 Published:2026-04-28
  • Contact: *WU Xinjuan，E-mail：wuxinjuan@sina.com
  • Supported by:
    National Key Research and Development Program of China(2022YFC2504505)

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摘要：

目的 构建适用于体外循环心脏手术患者术后早期在ICU内实施的呼吸康复管理方案。方法 通过系统文献回顾整合最佳证据，形成方案初稿；采用德尔菲法对来自9个省市13所三级甲等医院的15名重症医学、重症护理领域的专家进行2轮函询，最终构建方案。结果 2轮专家函询有效问卷回收率分别为93.75%和100%，专家权威系数分别为0.930和0.907，各条目变异系数分别为0~0.13和0~0.22，第2轮函询后肯德尔和谐系数为0.323（P<0.001），专家意见趋于一致。最终构建的方案包括12个主题、37个条目，涵盖多学科实施团队、开始时机、机械通气管理、镇静与镇痛、肺复张策略、呼吸肌训练、辅助呼吸训练、体位管理与早期活动、营养管理及安全性监测等呼吸康复全过程。结论 该方案聚焦于ICU场景，明确入ICU 24 h内启动康复，细化多学科职责与操作参数，实现了从指南建议到临床可执行步骤的转化，具有较强的科学性、实用性与可操作性，可为体外循环心脏手术患者术后早期呼吸康复提供系统化、规范化的实践指引。

关键词: 心脏手术, 体外循环, 呼吸康复, 德尔菲技术, 危重症护理

Abstract:

Objective To develop a respiratory rehabilitation program suitable for implementation in the early postoperative period in the ICU for patients undergoing cardiopulmonary bypass cardiac surgery. Methods A draft program was developed by synthesizing the best evidence through a systematic literature review. The Delphi method was then used to conduct two rounds of expert consultation with 15 specialists in critical care medicine and critical care nursing from 13 tertiary hospitals in 9 provinces across China，and the final program was established. Results The effective questionnaire recovery rates for the two rounds of Delphi consultation were 93.75% and 100%，respectively. The expert authority coefficients were 0.930 and 0.907，and the variation coefficients of each item were 0-0.13 and 0-0.22. After the second round，Kendall’s coefficient of concordance reached 0.323（P<0.001），indicating convergence of expert opinions. The final program comprises 12 themes and 37 items，covering the entire process of multidisciplinary collaboration，timing of initiation of respiratory rehabilitation，mechanical ventilation management，sedation and analgesia，lung recruitment strategies，respiratory muscle training，early mobilization，nutritional management，and safety monitoring. Conclusion This program is tailored to the ICU setting，specifies initiation of respiratory rehabilitation within 24 hours after surgery，and refines multidisciplinary roles and operational parameters，thereby translating guideline recommendations into executable clinical steps. It demonstrates strong scientific basis，practicality，and operability，and can provide systematic and standardized guidance for early postoperative respiratory rehabilitation in patients undergoing cardiopulmonary bypass cardiac surgery.

Key words: Cardiac Surgery, Cardiopulmonary Bypass, Respiratory Rehabilitation, Delphi Technique, Critical Care Nursing