早期离床活动对ICU机械通气患者谵妄的影响——一项前瞻性随机对照研究  

Effect of early off-bed mobility on delirium in mechanical ventilated patients in intensive care unit: a prospective randomized controlled study

作　　者：吴华炼 辜甜田 陈淼 李晓娟 张旭宁 王勇 权明桃 Wu Hualian;Gu Tiantian;Chen Miao;Li Xiaojuan;Zhang Xuning;Wang Yong;Quan Mingtao(Department of Intensive Care Unit,the Affiliated Hospital of Zunyi Medical University,Zunyi 563000,Guizhou,China)

机构地区：[1]遵义医科大学附属医院重症医学科,贵州遵义563000

出　　处：《中华危重病急救医学》2021年第11期1353-1357,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)。

摘　　要：目的探讨重症监护病房(ICU)机械通气患者早期离床活动实施的可行性及对患者谵妄及谵妄持续时间的影响。方法选择2020年1月1日至12月31日入住遵义医科大学附属医院综合ICU进行有创机械通气且无早期活动禁忌证的成人患者。按随机数字表法将患者分为两组,其中试验组进行早期离床活动干预,包括使用移位机离床坐、助行器辅助站立及行走,离床活动以患者耐受为宜;而对照组则进行早期床上活动,包括关节活动范围训练、四肢肢体运动、床上坐位、双上肢弹力带运动、双下肢脚踏车运动,每日1次,每个关节活动15~20次,共30 min。除早期活动干预方案不同外,所有患者均给予抗感染、机械通气、镇痛镇静、营养支持等治疗。使用ICU意识模糊评估量表(CAM-ICU)评估患者谵妄发生情况,记录患者谵妄持续时间、身体约束率、身体约束时长、机械通气时间、ICU住院时间。结果剔除干预期间死亡、放弃治疗等患者后,最终纳入266例,其中试验组133例,对照组133例。两组患者性别、年龄、入ICU诊断、病情程度、镇静药物使用情况等差异均无统计学意义。试验组谵妄发生率显著低于对照组〔26.3%(35/133)比42.1%(56/133),χ^(2)=7.366,P=0.007〕,谵妄持续时间较对照组明显缩短(h:11.26±4.11比17.00±3.29,t=-4.157,P=0.000),身体约束率低于对照组〔19.5%(26/133)比45.1%(60/133),χ^(2)=19.864,P=0.000〕,身体约束时长较对照组明显缩短(h:9.71±4.07比13.55±7.40,t=-5.234,P=0.000),机械通气时间、ICU住院时间均较对照组明显缩短〔机械通气时间(h):106.23±42.25比133.10±41.88,t=-3.363,P=0.001;ICU住院时间(d):8.35±6.21比13.25±9.98,t=-4.190,P=0.000〕。结论早期离床活动可减少危重患者身体约束率及谵妄发生率,加速患者康复,且ICU机械通气患者实施早期离床活动安全有效。Objective To investigate the feasibility of early off-bed mobility in patients with mechanical ventilation and its effect on delirium and the duration of delirium in the intensive care unit(ICU).Methods Adult patients who were admitted to ICU of the Affiliated Hospital of Zunyi Medical University from January 1st to December 31st 2020 for invasive mechanical ventilation and no early activity contraindication were selected.The patients were randomly divided into two groups.The experimental group conducted early off-bed mobility,such as using the shift machine off-bed sitting and walking aids to assist standing and walking,and the off-bed mobility is based on patient tolerance.The control group was given early bed activities,including conducting the joint range activity,limb movement,bed sitting,upper limb elastic belt movement,and lower limb cycling,once a day.Each joint moved 15-20 times,a total of 30 minutes.Both groups were treated with anti-infection,mechanical ventilation,analgesia and sedation,and nutrition therapy.After intervention,confusion assessment method for the ICU(CAM-ICU)was used to assess the onset and duration of delirium,physical restraint rate and duration of physical restraint,mechanical ventilation time,and the length of ICU stay.Results After excluding patients who died or gave up treatment during the intervention period,266 patients were included,with 133 patients in the experimental group and 133 patients in the control group.There were no significant differences in gender,age,diagnosis,degree of illness,sedative drugs between the two groups.The incidence of the delirium in intervention group was significantly lower than that in control group[26.3%(35/133)vs.42.1%(56/133),χ^(2)=7.366,P=0.007],the duration of delirium was shorter than that in control group(hours:11.26±4.11 vs.17.00±3.29,t=-4.157,P=0.000),the rate of physical restraint was lower than that in control group[19.5%(26/133)vs.45.1%(60/133),χ^(2)=19.864,P=0.000],the duration of physical restraint was shorter than that in contr

关 键 词：早期离床活动 机械通气 谵妄 谵妄持续时间 

分 类 号：R473[医药卫生—护理学]