机械通气患者早期运动康复研究进展  

Progress in early exercise rehabilitation of mechanical ventilation patients

作　　者：毛晶[1] 吴建贤[1] 张金牛 洪永锋[1] MAO Jing;WU Jian-xian;ZHANG Jin-niu;et al(Department of Rehabilitation Medicine, the Second Affiliated Hospital of Anhui Medical University, Hefei, Anhui 230601, China)

机构地区：[1]安徽医科大学第二附属医院康复医学科,安徽合肥230601

出　　处：《中华全科医学》2018年第9期1545-1549,共5页Chinese Journal of General Practice

基　　金：2013年安徽省级质量工程项目临床医学特色专业(康复医学;tszy011);2016年安徽省教育厅高校自然科学基金重点项目(K12016A346)

摘　　要：随着现代医学技术,尤其是危重症医学技术的快速发展,重症监护病房(ICU)应用机械辅助通气的急性呼吸衰竭患者(ARDS)的存活率较以往明显提高,随之而来的是幸存者的功能预后和生活质量的问题增加,为改善此类患者的功能预后,提高幸存者的生活质量,早期给予预防和康复就显得尤为重要。对于危重症患者开展早期的康复治疗,有利于防治并发症,预防功能障碍,减少卧床所致的心肺功能下降、骨骼肌无力等。早期的康复治疗也有助于缩短机械通气时间,实现尽早撤除机械辅助通气,达到降低医疗支出和改善幸存者后期生活质量的目的。其中重症监护室获得性肌无力(ICU-AW)是重症医学科患者的常见、严重的并发症,同时也是众多国内外学者近年来研究和关注的热点之一,但目前重症监护室获得性肌无力的治疗并无特效的药物。本文围绕ICU-AW,对其发病机制和危险因素、病情严重程度评估,机械辅助通气患者早期康复的可行性及临床获益,早期康复介入时机的选择和国际上早期康复治疗实施现状,目前早期康复治疗方式和方法,康复治疗过程的不良事件等研究进行综述。文章表明机械通气患者的早期康复是安全和有效的,早期康复治疗时不良事件发生率低,对于预防并发症,缩短机械通气时间和住院时间,改善患者预后和生活质量具有重要意义。With the rapid progress of modem medical technology, especially in critical care medicine, the survival rate of patients with acute respiratory failure（ARDS） with mechanical ventilation in the intensive care unit（ICU） has increased significantly, followed by the increase of the survivors＇ functional prognosis and the quality of life. In order to improve the functional prognosis of these patients and improve the quality of life of the survivors, early prevention and rehabilita- tion are particularly important. Early rehabilitation for critically ill patients is beneficial to preventing and treating compli- cations, reducing heart and lung function decline and skeletal muscle weakness in bed. Early rehabilitation treatment can also help shorten the time of mechanical ventilation, realize early withdrawal of mechanical auxiliary ventilation, and a- chieve the goal of reducing medical expenditure and improving the post-life quality of the survivor. Intensive care unit-ac- quired weakness（ICU-AW） is a common and serious complication of patients in 1CU. It is also one of the hot spots of re- search and attention of many domestic and foreign scholars in recent years, but there is no special drag for treatment at present. This article is based on the ICU-AW, its pathogenesis and risk factors, illness condition assessment, the feasi- bility and the clinical benefit of the early rehabilitation of the patients with mechanical ventilation, the treatment timing of early rehabilitation intervention, the status and implementation of early rehabilitation in the woad, early rehabilitation methods, the adverse events are all reviewed in this paper. These studies indicate that early rehabilitation of patients with mechanical ventilation is safe and effective, and the incidence of adverse events in early rehabilitation is low. It has the great significance to prevent complications, shorten the time of mechanical ventilation and hospital stay, and improve the prognosis and quality of their life.

关 键 词：机械通气 重症监护室获得性肌无力 早期康复 

分 类 号：R493[医药卫生—康复医学]