关键词: 撤机困难；分级肺康复；德尔菲法；方案构建

Abstract: Objective: To develop and apply a graded pulmonary rehabilitation program for patients with difficult weaning from mechanical ventilation, providing a reference for clinical management of patients. Methods: Based on literature review and two-round correspondence consultation with 20 experts, a program was developed. From January to June 2024, a convenience sample of 200 patients with difficult weaning from mechanical ventilation in five hospitals in Shanxi province were randomly divided into a control group and an intervention group, with 100 cases in each group. The control group received routine nursing care, while the intervention group received a graded pulmonary rehabilitation program. The respiratory function, mechanical ventilation time, and weaning success rate were compared between the two groups. Results: The final graded pulmonary rehabilitation program for patients with difficult weaning encompassed 22 specific measures across three dimensions: pulmonary rehabilitation assessment, pulmonary rehabilitation grading strategy, and safety monitoring during pulmonary rehabilitation. The intervention group had higher diaphragm thickening fraction, diaphragm mobility, maximum inspiratory pressure, maximum expiratory pressure, and weaning success rate than those in the control group, all with statistically significant differences (P<0.05). The mechanical ventilation duration in the intervention group was (18.75±3.04) days, which was shorter than (25.57±3.29) days in the control group, and the difference was statistically significant (P<0.001). Conclusion: The graded pulmonary rehabilitation program for patients with difficult weaning is scientific and clinically applicable. It can effectively improve patients' respiratory function, shorten the duration of mechanical ventilation, and increase the success rate of weaning.

Key words: difficult weaning; graded pulmonary rehabilitation; Delphi method; program development