经皮氧分压目标为导向的早期踏车运动在机械通气患者中的应用研究  

Application of early cycle ergometer exercise goal-oriented by transcutaneous oxygen partial pressure in mechanically ventilated patients

作　　者：黄艳林 赵雪芹 陈兴 刘彦飞[1] 向洋 李鑫瑜 汪子寒 HUANG Yanlin;ZHAO Xueqin;CHEN Xing;LIU Yanfei;XIANG Yang;LI Xinyu;WANG Zihan(The Third Central Hospital of Tianjin&Tianjin Key Laboratory of Extracorporeal Life Support for Critical Diseases&Tianjin Artificial Cell Engineering Technology Research Center&Tianjin Institute of Hepatobiliary Disease,Tianjin 300170,China;Tianjin Medical University,Tianjin 300070,China)

机构地区：[1]天津市第三中心医院重症医学科,天津市重症疾病体外生命支持重点实验室,天津市人工细胞工程技术研究中心,天津市肝胆疾病研究所,天津300170 [2]天津医科大学,天津300070

出　　处：《护士进修杂志》2024年第15期1650-1657,共8页Journal of Nurses Training

基　　金：天津市卫生健康科技项目(编号:KJ20012);天津市卫生健康科技项目(编号:TJWJ2022XK028);天津市医学重点学科(专科)建设项目(编号:TJYXZDXK-025A)。

摘　　要：目的探讨经皮氧分压[TcP(O_(2))]指导下的早期踏车运动在机械通气(mechanically ventilated,MV)患者中应用的可行性、有效性与安全性。方法选择天津市某三级甲等医院综合ICU 2021年3月-2023年2月符合纳排标准的96例患者为研究对象,进行一项历史对照研究,对照组(2021年3月-2022年2月)实施基于经验的早期康复运动(early rehabilitation mobilization,ERM);观察组(2022年3月-2023年2月)实施TcP(O_(2))目标导向的早期踏车运动。探索2种方案对MV患者临床结局与患者安全事件的影响。结果观察组单次平均康复运动时间较对照组短(t=-12.174,P<0.05),运动过程中最大Brog评分较对照组高(Z=-2.209,P=0.030),转出前行走能力得分较对照组高(Z=-2.279,P=0.023),2组转出前移动能力得分、ICU获得性衰弱(ICU-acquired weakness,ICU-AW)发生率、机械通气时间、ICU住院时间、最大吸气压(maximum inspiratory pressure,MIP)、谵妄发生率对比差异无统计学意义(P>0.05),2组均未发生不可逆转的安全事件。结论TcP(O_(2))目标导向早期踏车运动可提高MV患者转出时行走能力,促进患者机体功能恢复、提高临床康复工作效率的同时并未增加患者安全风险,兼具有效性、高效性与安全性。Objective To investigate the feasibility,effectiveness,and safety of early cycle ergometer exercise guided by transcutaneous partial pressure of oxygen [TcP(O_2)] in patients with mechanically ventilated(MV).Methods A total of patients who met with the inclusion and exclusion criteria were selected from March 2021 to February 2023 in the comprehensive ICU of a tertiary care hospital in Tianjin for a historical controlled study,and experience-based early rehabilitation movement(ERM) was implemented in the control group(March 2021 to February 2022),while early cycle ergometer exercise goal-oriented by TcP(O_2) was implemented in the intervention group(March 2022 to February 2023).The clinical outcomes of MV patients and patient safety events of 2 programs were explored.Results The intervention group had a shorter mean exercise duration(t=-12.174,P<0.05),a higher maximum Brog score during exercise(Z=-2.209,P=0.030),and walking ability score before transferring out of the ICU(Z=-2.279,P=0.023) than those in the control group.Mobility score before transferring out of the ICU,incidence of ICU-acquired weakness(ICU-AW),days of mechanical ventilation,length of ICU stay,maximum inspiratory pressure(MIP),and incidence of delirium were not statistically different between 2 groups(P>0.05),and no irreversible safety events occurred in either group.Conclusion Early cycle ergometer exercise goal-oriented by TcP(O_2) can improve MV patients' walking ability,promote functional recovery,and improve efficiency of clinical rehabilitation without increasing safety risk,showing that it is effective,efficient,and safe.

关 键 词：经皮氧分压 踏车运动 呼吸 人工 机械通气 早期康复运动 预后 

分 类 号：R473[医药卫生—护理学]