早期下床活动对ICU机械通气患者成功撤机的影响  

Effect of early off-bed mobility on successful weaning of mechanically ventilated patients in the ICU

作　　者：吴良风 周全[1] 王箴[1] 张鹏[1] 江海娇[1] 孙瑞祥 杨尚志 柳军 陶秀彬[1] WU Liang-feng(Department of Intensive Care Medicine,Yiji Mountain Hospital,Wannan Medical College,Wuhu 234100,China)

机构地区：[1]皖南医学院弋矶山医院重症医学科,安徽芜湖234100 [2]皖南医学院弋矶山医院康复科,安徽芜湖234100

出　　处：《牡丹江医学院学报》2023年第2期88-94,共7页Journal of Mudanjiang Medical University

基　　金：国家临床重点专科建设项目;安徽省科技计划项目(1604f0804043);安徽省中央引导地方科技发展专项项目(201907d07050001);弋矶山医院科技创新团队"攀峰"培育计划(PF2019014)。

摘　　要：目的探讨重症监护病房(ICU)机械通气患者早期下床活动实施的可行性及对ICU机械通气脱机困难患者的撤机成功率,二次插管率、呼吸机相关性肺炎发生率以及机械通气时间等的影响。方法选择2020年12月1日至2021年10月31日入住皖南医学院弋矶山医院综合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137名患者分为两组,其中实验组68例,对照组69例。试验组进行早期下床活动干预,而对照组则进行早期床上活动,除早期活动干预方案不同外,所有患者治疗和护理均相同。统计机械通气患者撤机成功率、二次插管率、呼吸机相关性肺炎发生率。记录患者机械通气时间、谵妄发生率及持续时间、身体约束率、身体约束时长、ICU住院时间。结果实验组的撤机成功率65例(95.58%)与对照组撤机成功率40例(57.97%)比较,撤机成功率明显提高,两组VAP发生率实验组1例(1.47%)和对照组5例(7.25%)相比较明显降低;实验组的机械通气时间(74.59±24.10)h和ICU住院时间(5.00±3.18)d较对照组机械通气时间(96.43±26.53)h和ICU住院时间(7.00±8.42)d较少,实验组谵妄发生率3例(4.4%)与对照组谵妄发生率3例(4.3%)相比较无明显差异,但实验组谵妄持续时间(19.30±3.4)h较对照组(52.00±14.97)h降低;实验组约束率68例(100%)与对照组约束率69例(100%)相比较无明显差异;实验组的48 h再插管率0例(0%)与对照组6例(8.60%)相比较明显降低;两组28 d生存率相比较无明显差异,但两组再入ICU率结果比较实验组0%和对照组4例(5.79%)明显降低;实验组的ICU住院费用(10.28±1.74)万元与对照组(9.45±3.30)万元相比较降低,且住院总时间也缩短。结论早期下床活动可提高ICU机械通气延迟撤机患者的撤机成功率,减少二次插管率和机械通气时间,早期下床活动可能减少对谵妄发生,且ICU机械通气患者实施早期下床活动安全有效。Objective To investigate the feasibility of implementing early off-bed activities in mechanically ventilated patients in the intensive care unit(ICU),and explore its effects on the successful weaning rate,secondary intubation rate,incidence of ventilator-associated pneumonia,and duration of mechanical ventilation of patients with mechanical ventilation deconditioning difficulties,and so on.Methods dult patients,admitted to the comprehensive ICU of Yiji Shan Hospital of Wannan Medical College for invasive mechanical ventilation from December 1,2020 to October 31,2021 and had no contraindications to early activity,were selected.The 137 patients were divided into two groups according to the random number table method,including 68 cases in the experimental group and 69 cases in the control group.The experimental group did not undergo early off-bed activity while the control group was opposite.All patients were treated and cared for identically except for the early activity intervention protocol.The successful weaning rate,secondary intubation rate,and incidence of ventilator-associated pneumonia in mechanically ventilated patients were counted.The duration of mechanical ventilation,incidence and duration of delirium,rate of physical restraint,length of physical restraint,and length of ICU stay of patients were recorded.Results The 65 cases(95.58%)of successful weaning patients in the experimental group was significantly higher compared with 40 cases(57.97%)in the control group,and the incidence of VAP was significantly lower in 1 case(1.47%)in the experimental group compared with 5 cases(7.25%)in the control group.The duration of mechanical ventilation(74.59±24.1)h and ICU stay(5.00±3.18 d)was less than that of the control group(96.43±26.53)h and ICU stay(7.00±8.42)d,and the incidence of delirium in the experimental group(4.4%)was not significantly different from that of the control group(4.3%),but the duration of delirium in the experimental group(19.30±3.4)h was lower than that of the control group(52.00±14.9

关 键 词：早期活动 延迟撤机 机械通气 呼吸机相关肺炎 谵妄 

分 类 号：R73[医药卫生—肿瘤]