摘要
目的:探讨对重症监护病房(ICU)机械通气患者实施早期离床活动干预后膈肌功能的改善情况。方法:采用随机对照的研究设计方法,选择2019年10月至2022年3月遵义医科大学附属医院重症医学科收治的147例成人机械通气患者作为研究对象,采用便利抽样法将患者分为对照组和观察组。两组患者除早期活动的干预方案不同外,其他治疗及护理均按照ICU常规实施。对照组实施渐进性早期活动,而观察组则实施早期离床活动。比较两组患者干预前及干预24、48、72、96 h吸气末膈肌厚度(DTei)、呼气末膈肌厚度(DTee)和膈肌增厚分数(DTF)的变化,以及干预后患者机械通气时间、ICU住院时间和24 h重插管率。结果:147例患者中,对照组脱落4例,观察组脱落5例,最终138例患者纳入分析,对照组与观察组各69例。两组患者性别、年龄、入ICU诊断、镇静药物、肌力、呼吸机模式、急性生理学与慢性健康状况评分Ⅱ(APACHEⅡ)及干预前DTei、DTee、DTF等基线资料差异均无统计学意义。两组患者DTei、DTee、DTF随干预时间延长逐渐上升,以观察组变化更加明显〔干预24、48、72、96 h观察组DTei(cm)分别为0.247±0.014、0.275±0.016、0.300±0.013、0.329±0.013,对照组分别为0.242±0.015、0.258±0.013、0.269±0.014、0.290±0.017,时间效应:F=993.825、P=0.000,干预效应:F=82.304、P=0.000,干预与时间的交互效应:F=84.457、P=0.000;观察组DTee(cm)分别为0.213±0.014、0.227±0.013、0.243±0.016、0.264±0.010,对照组分别为0.213±0.016、0.218±0.013、0.224±0.013、0.234±0.014,时间效应:F=385.552、P=0.000,干预效应:F=28.161、P=0.000,干预与时间的交互效应:F=45.012、P=0.000;试验组DTF分别为(15.98±4.23)%、(21.35±4.67)%、(24.09±4.44)%、(25.24±3.74)%,对照组分别为(14.17±4.66)%、(18.11±3.92)%、(20.22±4.19)%、(20.98±4.12)%,时间效应:F=161.552、P=0.000,干预效应:F=49.224、P=0.000,干预与时间的交互效应
Objective To explore the improvement of diaphragm function after early off-bed mobility intervention in intensive care unit(ICU)patients undergoing mechanical ventilation.Methods A randomized controlled trial was conducted.A total of 147 adult patients undergoing mechanical ventilation admitted to ICU of Affiliated Hospital of Zunyi Medical University from October 2019 to March 2022 were enrolled.The patients were divided into control group and observation group by convenient sampling.Except for the different intervention programs of early mobility,other treatment and nursing of the patients in the two groups were carried out according to ICU routine.Progressive early activities were performed in the control group,while early off-bed mobility was performed in the observation group.The changes of diaphragm thickness at the end of inspiratory(DTei),diaphragm thickness at the end of expiratory(DTee)and diaphragm thickening fraction(DTF)before and 24,48,72 and 96 hours of intervention,and the duration of mechanical ventilation,length of ICU stay and 24-hour re-intubation rate after intervention were compared between the two groups.Results Among the 147 patients,there were 4 cases of detachment in the control group and 5 cases of detachment in the observation group.Finally,138 patients were enrolled,69 cases in the control group and 69 cases in the observation group.There was no significant difference in gender,age,diagnosis of ICU,sedatives,muscle strength,ventilator model,acute physiology and chronic health evaluationⅡ(APACHEⅡ)score and DTei,DTee,DTF before intervention between the two groups.The DTei,DTee and DTF in both groups were increased gradually with the extension of intervention time,especially in the observation group[DTei(cm)at 24,48,72 and 96 hours of intervention in the observation group were 0.247±0.014,0.275±0.016,0.300±0.013 and 0.329±0.013,while in the control group were 0.242±0.015,0.258±0.013,0.269±0.014,and 0.290±0.017,effect of time:F=993.825,P=0.000,effect of intervention:F=82.304,P
作者
吴华炼
王小鹏
陈淼
陈俊希
陈红艳
王本金
权明桃
Wu Hualian;Wang Xiaopeng;Chen Miao;Chen Junxi;Chen Hongyan;Wang Benjin;Quan Mingtao(Department of Intensive Care Unit,the Affiliated Hospital of Zunyi Medical University,Zunyi 563000,Guizhou,China)
出处
《中华危重病急救医学》
CAS
CSCD
北大核心
2023年第8期870-874,共5页
Chinese Critical Care Medicine
基金
国家临床重点专科建设项目(2013-544)
遵义医学院附属医院硕士科研启动基金(2018-45)。
关键词
早期离床活动
机械通气
膈肌厚度
膈肌增厚分数
Early out-of-bed exercise
Mechanical ventilation
Diaphragm thickness
Diaphragm thickening fraction
