早期康复训练对机械通气的患者的影响  

The effects of early rehabilitation therapy in mechanically ventilated patients

作　　者：董泽华[1] 于帮旭[1] 孙运波[1] 方巍[1] 李蕾[1] 

机构地区：[1]青岛大学医学院附属医院重症医学科,山东省青岛266003

出　　处：《中华急诊医学杂志》2013年第10期1153-1156,共4页Chinese Journal of Emergency Medicine

摘　　要：目的探讨机械通气患者进行早期康复训练对预后的影响。方法前瞻性随机对照实验研究，选择2010年5月至2012年5月在青岛大学医学院附属医院重症医学科收治的机械通气时间大于48h少于72h的60例患者，随机（随机数字法）分为康复训练组和对照组，每组各30例。康复训练组患者每日进行两次康复训练，康复训练的时间和强度根据患者病情调整，早期康复训练包括主动抬头、由平卧位到坐位、端坐床边、床旁坐位、床旁站立和床旁行走。比较康复训练组和对照组患者的体质量指数、首次床旁坐位时间、机械通气时间、ICU住院时间、APACHEⅡ评分、最高FiO2、最低PaO2／FiO2和住院病死率。组问差异比较采用成组t检验。结果两组患者的体质量指数、APACHEⅡ评分、最高FiO2、最低PaO2／Fi02和住院病死率差异无统计学意义（P均〉0．05），康复训练组的首次床旁坐位时间（3．8±1．2）d、机械通气时间（5．6±2．1）d、ICU住院时间（7．3±2．8）d与对照组的首次床旁坐位时间（14．9±4．7）d、机械通气时间（12．7±4．1）d、ICU住院时间（15．2±4．5）d相比较均明显缩短（P均〈0．05）。结论本研究表明机械通气患者在重症医学科住院期间进行早期康复训练安全有效，可明显缩短机械通气时间、ICU住院时间和改善患者的预后。Objective To investigate the effects of early rehabilitation therapy in mechanically ventilated ICU in patients. Methods A randomized controlled trial was carried out. Sixty mechanically ventilated patients, with tracheal intubation or traeheostomy more than 48 b and less than 72 h, were admitted to the intensive care unit （ICU） of the Affiliated Hospital of Medical College Qingdao University from May 2010 to May 2012. These patients were randomly （random number） divided into two groups, the rehabilitation group and the control group, 30 patients in each group. In rehabilitation group, rehabilitation therapy was taken twice daily, and the （raining time and intensity was adjusted according to the condition of the patients. Early rehabilitation therapy included head up actively, transfer from the supine to sit, out of bed, transfer to a chair, standing bedside bed and walking bedside bed. The patient＇s body mass index, days to first out of bed, duration of mechanical ventilation, ICU stay, APACHE Ⅱ score, highest FiO2, lowest PaO2/FiO2 and hospital mortality of patients were compared between rehabilitation group and control group. The differences between the groups were compared using t test. Results There was no significant difference in body mass index, APACHE Ⅱ score, highest FiO2 , lowest PaOJFiO2 and hospital mortality between rehabilitation group and control group （P 〉 0. 05）. Patients in the rehabilitation group had shorter first out of bed time [ （3. 8 ± 1.2） d vs. （ 14. 9 ± 4.7 ） d; P = 0.00 ], duration of mechanical ventilation [ （5.6±2.1） dvs. （12.7±4.1） d; P=0.005] andlCUstay [ （7.3±2.8） dvs. （15.2±4.5） d; P = 0. 01 ] compared with control group. Conclusions Early rehabilitation therapy was safe and effective in improving the outcomes of mechanical ventilation patient.

关 键 词：早期康复训练 机械通气 重症监护 ICU住院时间 住院病死率 APACHEⅡ评分 预后 影响因素 

分 类 号：R459.7[医药卫生—急诊医学]