早期渐进性活动训练促进重症监护病房机械通气患者神经肌肉功能恢复的效果观察

摘要

目的 探讨早期渐进性活动训练促进重症监护病房(intensive care unit,ICU)机械通气患者神经肌肉功能恢复的效果.方法 将98例ICU机械通气患者随机分为实验组和对照组,每组各49例,实验组患者在镇静中断后每天实施两次早期渐进性活动训练;对照组患者每天两次接受床上被动或主动全范围关节活动.采用功能独立性评分表(functional independence measure,FIM)对两组患者分别在拔除气管插管时、转出ICU时和出院时进行评定,并比较两组患者住院期间并发症发生情况.结果 实验组患者在拔除气管插管时FIM总分及自理能力、括约肌控制、转移方面得分明显高于对照组,两组比较,均P＜0.05,差异具有统计学意义;实验组患者在转出ICU时和出院时在FIM总分及5个方面得分明显高于对照组,两组比较,均P＜0.05,差异具有统计学意义.实验组患者呼吸机相关性肺炎(ventilator associated pneumonia,VAP)、下肢深静脉栓塞(deep vein thrombosis,DVT)的发生率明显低于对照组,两组比较,均P＜0.05,差异具有统计学意义.结论 早期渐进性活动训练能促进ICU机械通气患者神经肌肉功能恢复,并可降低相关并发症的发生率.%Objective To study the effect of early progressive exercises on neuromuscular function recovery of mechanically ventilated patients in intensive care unit. Methods 98 mechanically ventilated patients in the ICU were randomly divided into the experiment group and the control group, 49 patients in each group. Patients in the experiment group were implemented the training program of early progressive exercise twice a day once the sedation was cut off. Patients in the control group were implemented early passive or active training of joint activities in a full range on bed twice a day. The two groups were assessed in terms of complications using the Functional Independence Measures at the time of extubation, shifting out of ICU and discharge from the hospital. Results At the time of extubation, the experiment group was scored significantly higher the control group in terms of FIM total score, self-care activity and control and transfer of sphincter (P< 0.05). At the time of shifting out of ICU and discharge from the hospital, the experiment group was also scored higher than the control in terms of FIM total scores and other 5 factors (P < 0.05). The incidences of ventilator associated pneumonia and deep vein thrombosis in the experiment group were both significantly lower than those of the control group (P < 0.05). Conclusion The training program of early progressive exercise may promote the recovery of neuromuscular function of mechanically ventilated patients in the ICU and reduce the incidence of other related complications.