Objective:The early use of neuromuscular electrical stimulation(NMES)to prevent intensive care unit-acquired weakness(ICU-AW)in critical patients is still a controversial topic.We conducted a systematic review to clar...Objective:The early use of neuromuscular electrical stimulation(NMES)to prevent intensive care unit-acquired weakness(ICU-AW)in critical patients is still a controversial topic.We conducted a systematic review to clarify the effectiveness of NMES in preventing ICU-AW.Methods:The Cochrane Library,PubMed,EMBASE,MEDUNE,Web of Science,Ovid,CNKI,Wanfang,VIP,China Biology Medicine disc(CBMdisc)and other databases were searched for randomized controlled trials on the influence of NMES on ICU-AW.The studies were selected according to the inclusion and exclusion criteria.After data and quality were evaluated,a meta-analysis was performed by RevMan 5.3 software.Results:A total of 11 randomized controlled trials with 576 patients were included.The meta-analysis results showed that NMES can improve muscle strength[MD=1.78,95%CI(0.44,3.12,P=0.009);shorten the mechanical ventilation(MV)time[SMD=-0.65,95%CI(-1.03,-0.27,P=0.001],ICU length of stay[MD=-3.41,95%CI(-4.58,-4.24),P<0.001],and total length of stay[MD=-3.97,95%CI(-6.89,-1.06,P=0.008];improve the ability of patients to perform activities of daily living[SMD=0.9,95%CI(0.45,1.35),P=0.001];and increase walking distance[MD=239.03,95%CI(179.22298.85),P<0.001].However,there is no evidence indicating that NMES can improve the functional status of ICU patients during hospitalization,promote the early awakening of patients or reduce mortality(P>0.05).Conclusion:Early implementation of the NMES intervention in ICU patients can prevent ICU-AW and improve their quality of life by enhancing their muscle strength and shortening the MV duration,length of stay in the ICU and total length of stay in the hospital.展开更多
Intensive care unit-acquired weakness(ICU-AW)is a common complication in critically ill patients and is associated with a variety of adverse outcomes.These include the need for prolonged mechanical ventilation and ICU...Intensive care unit-acquired weakness(ICU-AW)is a common complication in critically ill patients and is associated with a variety of adverse outcomes.These include the need for prolonged mechanical ventilation and ICU stay;higher ICU,in-hospital,and 1-year mortality;and increased in-hospital costs.ICU-AW is associated with multiple risk factors including age,underlying disease,severity of illness,organ failure,sepsis,immobilization,receipt of mechanical ventilation,and other factors related to critical care.The pathological mechanism of ICUAW remains unclear and may be considerably varied.This review aimed to evaluate recent insights into ICU-AW from several aspects including risk factors,pathophysiology,diagnosis,and treatment strategies;this provides new perspectives for future research.展开更多
ICU获得性衰弱(intensive care unit acquired weakness,ICU-AW)作为重症监护室脓毒症患者的常见并发症,多累及骨骼肌、呼吸肌及平滑肌等,会导致脱机困难、住院时间延长、医疗费用剧增,并严重影响患者远期生活质量。但脓毒症ICU-AW的发...ICU获得性衰弱(intensive care unit acquired weakness,ICU-AW)作为重症监护室脓毒症患者的常见并发症,多累及骨骼肌、呼吸肌及平滑肌等,会导致脱机困难、住院时间延长、医疗费用剧增,并严重影响患者远期生活质量。但脓毒症ICU-AW的发病机制尚不明确、诊断评估标准缺乏统一、治疗时机和方案选择仍无具体标准。鉴于该病发病机制和诊疗选择存在争议,本文结合国内外文献资料,对脓毒症患者ICU-AW的发病机制及诊疗措施相关研究进展进行综述,以期加深临床多学科对该病的认知并针对性提高疾病的早期认识、诊断及诊疗协作能力。展开更多
目的确切了解脑卒中后中枢性面瘫闭目乏力的发生率,探讨其发生机制。方法观察1年内所有起病7 d 内入院的脑卒中患者。使用美国国立卫生院脑卒中量表(National Institute ofHealth stroke scale,NIHSS)中第4项面瘫评分及日本面瘫评分(Jap...目的确切了解脑卒中后中枢性面瘫闭目乏力的发生率,探讨其发生机制。方法观察1年内所有起病7 d 内入院的脑卒中患者。使用美国国立卫生院脑卒中量表(National Institute ofHealth stroke scale,NIHSS)中第4项面瘫评分及日本面瘫评分(Japan facial score,JFS)进行面瘫评估,使用拉力测量器测量双侧眼轮匝肌的闭目力量差值。比较中枢性面瘫者伴与不伴闭目乏力两组的临床资料。结果共收集病例914例,中枢性面瘫者伴闭目乏力且头颅 MRI 显示脑干无病灶者共40例,发生率为4.4%。脑卒中后中枢性面瘫伴闭目乏力者的双眼闭目力量差值随时间延长而递减(F=36.049,P<0.01),而不伴闭目乏力者双眼闭目力量无差异。伴闭目乏力者的责任病灶在右侧大脑半球的比例较不伴闭目乏力者高(72.50% vs 32.01%,X^2=32.95,P<0.01)。两组的责任病灶的性质、分布部位、体积、Alberta 卒中计划早期 CT 评分、有双侧病灶的比例均无差异。责任病灶分布在右侧大脑半球、年龄、性别以及是否有脑干病变这四项因素作为 Cox 回归的协变量,对中枢性面瘫闭目乏力的持续时间均无影响。结论脑卒中后中枢性面瘫伴闭目乏力的发生率达4.4%,其发生机制可能与右侧大脑半球受损有关。展开更多
Objective:This study aimed to evaluate the effectiveness of Buerger-Allen exercise(BAE)in reducing muscle cramps among recently extubated patients in the intensive care unit(ICU).Materials and Methods:A quantitative,q...Objective:This study aimed to evaluate the effectiveness of Buerger-Allen exercise(BAE)in reducing muscle cramps among recently extubated patients in the intensive care unit(ICU).Materials and Methods:A quantitative,quasi-experimental design was employed,involving 92 recently extubated ICU patients randomly assigned to either an experimental or control group.The experimental group underwent BAE,a three-step intervention targeting lower extremity circulation and muscle cramp reduction.The exercises included the elevation of lower extremities,foot and leg exercises,and a rest and recovery phase,administered twice daily for 10 days.The control group received standard nursing care without any specific exercise regimen.Muscle cramp severity was assessed using the modified Penn Spasm Frequency Scale before and after the intervention.Results:The experimental group showed a significant reduction in muscle cramp severity score postintervention,with the mean scores decreasing from 6.83±1.66 to 4.22±1.45(t=10.21,P=0.001).The control group experienced a smaller reduction,with scores decreasing from 6.98±1.57 to 6.43±1.37(t=2.810,P=0.007).Between-group analysis confirmed a significant difference postintervention,with the experimental group improving more(t=8.242,P=0.001).The Mann–Whitney U test also highlighted a significant difference between groups after the intervention(U=494.5,P=0.001),validating the effectiveness of BAE.Conclusion:BAE significantly reduces muscle cramp severity in recently extubated ICU patients,suggesting that this nonpharmacological intervention can effectively improve patient outcomes and aid in postextubation recovery.展开更多
基金This work was supported by the Chinese Nursing Association research program[ZHKY201611].
文摘Objective:The early use of neuromuscular electrical stimulation(NMES)to prevent intensive care unit-acquired weakness(ICU-AW)in critical patients is still a controversial topic.We conducted a systematic review to clarify the effectiveness of NMES in preventing ICU-AW.Methods:The Cochrane Library,PubMed,EMBASE,MEDUNE,Web of Science,Ovid,CNKI,Wanfang,VIP,China Biology Medicine disc(CBMdisc)and other databases were searched for randomized controlled trials on the influence of NMES on ICU-AW.The studies were selected according to the inclusion and exclusion criteria.After data and quality were evaluated,a meta-analysis was performed by RevMan 5.3 software.Results:A total of 11 randomized controlled trials with 576 patients were included.The meta-analysis results showed that NMES can improve muscle strength[MD=1.78,95%CI(0.44,3.12,P=0.009);shorten the mechanical ventilation(MV)time[SMD=-0.65,95%CI(-1.03,-0.27,P=0.001],ICU length of stay[MD=-3.41,95%CI(-4.58,-4.24),P<0.001],and total length of stay[MD=-3.97,95%CI(-6.89,-1.06,P=0.008];improve the ability of patients to perform activities of daily living[SMD=0.9,95%CI(0.45,1.35),P=0.001];and increase walking distance[MD=239.03,95%CI(179.22298.85),P<0.001].However,there is no evidence indicating that NMES can improve the functional status of ICU patients during hospitalization,promote the early awakening of patients or reduce mortality(P>0.05).Conclusion:Early implementation of the NMES intervention in ICU patients can prevent ICU-AW and improve their quality of life by enhancing their muscle strength and shortening the MV duration,length of stay in the ICU and total length of stay in the hospital.
基金supported by grants from the National Natural Science Foundation of China(grant number:82072201).
文摘Intensive care unit-acquired weakness(ICU-AW)is a common complication in critically ill patients and is associated with a variety of adverse outcomes.These include the need for prolonged mechanical ventilation and ICU stay;higher ICU,in-hospital,and 1-year mortality;and increased in-hospital costs.ICU-AW is associated with multiple risk factors including age,underlying disease,severity of illness,organ failure,sepsis,immobilization,receipt of mechanical ventilation,and other factors related to critical care.The pathological mechanism of ICUAW remains unclear and may be considerably varied.This review aimed to evaluate recent insights into ICU-AW from several aspects including risk factors,pathophysiology,diagnosis,and treatment strategies;this provides new perspectives for future research.
文摘ICU获得性衰弱(intensive care unit acquired weakness,ICU-AW)作为重症监护室脓毒症患者的常见并发症,多累及骨骼肌、呼吸肌及平滑肌等,会导致脱机困难、住院时间延长、医疗费用剧增,并严重影响患者远期生活质量。但脓毒症ICU-AW的发病机制尚不明确、诊断评估标准缺乏统一、治疗时机和方案选择仍无具体标准。鉴于该病发病机制和诊疗选择存在争议,本文结合国内外文献资料,对脓毒症患者ICU-AW的发病机制及诊疗措施相关研究进展进行综述,以期加深临床多学科对该病的认知并针对性提高疾病的早期认识、诊断及诊疗协作能力。
文摘Objective:This study aimed to evaluate the effectiveness of Buerger-Allen exercise(BAE)in reducing muscle cramps among recently extubated patients in the intensive care unit(ICU).Materials and Methods:A quantitative,quasi-experimental design was employed,involving 92 recently extubated ICU patients randomly assigned to either an experimental or control group.The experimental group underwent BAE,a three-step intervention targeting lower extremity circulation and muscle cramp reduction.The exercises included the elevation of lower extremities,foot and leg exercises,and a rest and recovery phase,administered twice daily for 10 days.The control group received standard nursing care without any specific exercise regimen.Muscle cramp severity was assessed using the modified Penn Spasm Frequency Scale before and after the intervention.Results:The experimental group showed a significant reduction in muscle cramp severity score postintervention,with the mean scores decreasing from 6.83±1.66 to 4.22±1.45(t=10.21,P=0.001).The control group experienced a smaller reduction,with scores decreasing from 6.98±1.57 to 6.43±1.37(t=2.810,P=0.007).Between-group analysis confirmed a significant difference postintervention,with the experimental group improving more(t=8.242,P=0.001).The Mann–Whitney U test also highlighted a significant difference between groups after the intervention(U=494.5,P=0.001),validating the effectiveness of BAE.Conclusion:BAE significantly reduces muscle cramp severity in recently extubated ICU patients,suggesting that this nonpharmacological intervention can effectively improve patient outcomes and aid in postextubation recovery.
