渐进式早期活动方案在ICU机械通气患者中的应用  

Implementation of the progressive early activity plan in ICU patients undergoing mechanical ventilation

作　　者：成晶 梁敏[1] 陈琼[2] 王淑芳[1] 田兰 CHENG Jing;LIANG Min;CHEN Qiong;WANG Shufang;TIAN Lan(Department of Critical Care Medicine,Changsha Central Hospital,Changsha,410000,China)

机构地区：[1]长沙市中心医院重症医学科,长沙市410000 [2]长沙市中心医院急诊科,长沙市410000

出　　处：《中国护理管理》2024年第10期1481-1486,共6页Chinese Nursing Management

基　　金：湖南省自然科学基金项目(2023JJ60406);长沙市中心医院科研立项项目(YNKY202237)。

摘　　要：目的 :评价对ICU机械通气患者实施渐进式早期活动方案的有效性及安全性,为促进ICU机械通气患者早期活动提供参考。方法 :便利选取2022年1月—11月湖南省某三级甲等综合医院ICU收治的68例机械通气患者为研究对象,随机分为对照组与干预组各34例。对照组实施ICU机械通气患者护理常规及常规功能锻炼,干预组实施基于《国际功能、残疾和健康分类》理念,即从身体功能训练、日常活动训练及环境声光控制3个方面对患者实施渐进式早期活动方案,比较两组患者机械通气时间、ICU住院时间、下肢深静脉血栓发生率、谵妄发生率、肌力、ICU获得性衰弱发生率、不良事件发生率及潜在不良事件发生率。结果 :干预组患者机械通气时间、ICU住院时间短于对照组(P<0.05),干预组患者谵妄发生率及ICU获得性衰弱发生率低于对照组(P<0.05),干预组患者肌力高于对照组(P<0.05),两组患者不良事件发生率差异无统计学意义(P>0.05),干预组患者潜在不良事件发生率高于对照组(P<0.05)。结论 :渐进式早期活动方案是一种有效且安全可行的干预方案,可缩短ICU患者机械通气时间及ICU住院时间,预防其谵妄及ICU获得性衰弱的发生,并改善患者肌力。同时,ICU医护人员需要关注机械通气患者早期活动过程中潜在不良事件的预防,以确保早期活动实施的安全性。Objective:To explore the effectiveness and safety of implementing a progressive early activity plan based on the International Classification of Functioning,Disability and Health(ICF)concept for ICU mechanically ventilated patients,so as to provide a reference plan for early activity of ICU mechanically ventilated patients.Methods:Totally sixty eight mechanically ventilated patients admitted to the intensive care department of a tertiary grade A comprehensive hospital in Hunan province from January to November 2022 were recruited and randomly divided into a control group and an intervention group.The control group carried out routine nursing care and functional exercises for ICU mechanically ventilated patients,while the intervention group received a progressive early activity plan based on the ICF concept,which included physical function training,daily activity training,and environmental sound and light control.The mechanical ventilation time,ICU stay time,muscle strength,incidence of lower limb deep vein thrombosis,delirium,ICU acquired weakness,adverse events,and potential incidence of adverse events were compared between the two groups of patients.Results:The intervention group had less mechanical ventilation time and ICU hospitalization time than the control group(P<0.05).The incidence of delirium and ICU acquired weakness in the intervention group was lower than that in the control group(P<0.05).The intervention group had higher muscle strength than the control group(P<0.05).There was no statistically significant difference in the incidence of adverse events between the two groups(P>0.05).The potential incidence of adverse events in the intervention group was higher than that in the control group(P<0.05).Conclusion:The progressive early activity program based on the ICF concept is an effective and safe intervention program that can shorten the mechanical ventilation time and ICU hospitalization time of ICU patients,prevent delirium and ICU acquired weakness,and improve patient muscle strength.At the same ti

关 键 词：国际功能、残疾和健康分类 重症 机械通气 早期活动 

分 类 号：R47[医药卫生—护理学] R197[医药卫生—临床医学]