神经肌肉电刺激对急性重症胰腺炎合并ARDS患者肌肉力量改善效果评估  

Efficacy assessment for NMES in improving muscle strength in patients with SAP complicated by ARDS

作　　者：范定容 周恒宇 蔡莹[2] 谭波涛[3] 王倩倩 周凤 冉晓芸 陈晓东[4] 沈奥 FAN Dingrong;ZHOU Hengyu;CAI Ying;TAN Botao;WANG Qianqian;ZHOU Feng;RAN Xiaoyun;CHEN Xiaodong;SHEN Ao(Department of Pediatrics,the Second Affiliated Hospital of Chongqing Medical University,Chongqing,400016,China;School of Nursing,the Second Affiliated Hospital of Chongqing Medical University,Chongqing,400016,China;Department of Rehabilitation Medicine,the Second Affiliated Hospital of Chongqing Medical University,Chongqing,400016,China;Department of Critical Care Medicine,the Second Affiliated Hospital of Chongqing Medical University,Chongqing,400016,China)

机构地区：[1]重庆医科大学附属第二医院儿科,重庆400016 [2]重庆医科大学附属第二医院护理学院,重庆400016 [3]重庆医科大学附属第二医院康复医学科,重庆400016 [4]重庆医科大学附属第二医院重症医学科,重庆400016

出　　处：《陆军军医大学学报》2024年第22期2539-2546,共8页Journal of Army Medical University

基　　金：重庆市教委科学技术研究计划项目(KJQN202200413);重庆市科卫联合项目(2023MSXM037)。

摘　　要：目的评估在早期应用神经肌肉电刺激(neuromuscular electrical stimulation,NMES)对急性重症胰腺炎(severe acute pancreatitis,SAP)合并急性呼吸窘迫综合征(acute respiratory distress syndrome,ARDS)患者肌肉力量、临床结局、远期生活质量改善的影响。方法纳入2022年9月至2023年8月入住重庆医科大学附属第二医院重症医学科及急诊重症医学病区符合SAP合并ARDS诊断的患者75例。采用随机数字表法对入组患者进行分组:NMES组(n=37)和对照组(n=38),排除治疗过程中死亡8例、出院3例、姑息治疗5例,最终纳入59例患者,其中NMES组29例、对照组30例。NMES组从ICU入院48 h开始,在常规康复基础上额外行NMES治疗,连续7 d,每天1 h,直至患者离开ICU或因病情不适合继续康复锻炼为止。对照组进行常规康复治疗。在治疗结束后,评估患者ICU获得性虚弱(ICU-acquired weakness,ICU-AW)发生率;医学研究委员会肌力评分(Medical Research Council-score,MRC);机械通气时间、ICU住院时间、总住院时间;膈肌活动度、膈肌厚度及膈肌增厚分数(diaphragmatic thickening fraction,DTF);随访患者出院后第1、3、6个月病死率及Barthel自理能力评分(Barthel Index,BI)。结果NMES组患者ICU-AW发生率低于对照组(P<0.05);出ICU时上肢、下肢MRC评分以及MRC总评分均高于对照组(P<0.05);NMES组机械通气时间、ICU住院时间、总住院时间均低于对照组(P<0.05)。2组患者出院后第1个月Barthel自理能力评分差异无统计学意义,但第3、6个月Barthel自理能力评分NMES组高于对照组(P<0.05)。2组患者入组当天、出ICU当天、出院当天,膈肌活动度、膈肌厚度、膈肌增厚分数无明显差异,出院后第1、3、6个月病死率无统计学差异。结论NMES联合早期康复治疗可改善SAP合并ARDS患者肌肉力量、缩短住院时间,并可能改善远期生活质量,但对膈肌功能和死亡率无明显影响。Objective To evaluates the impact of early application of neuromuscular electrical stimulation(NMES)on muscle strength,clinical outcomes,and long-term quality of life improvements in patients with severe acute pancreatitis(SAP)complicated with acute respiratory distress syndrome(ARDS).Methods A total of 75 patients diagnosed with SAP and ARDS admitted in Department of Critical Care Medicine of our hospital from September 2022 to August 2023 were recruited and then randomly divided into NMES group(n=37)and control group(n=38).After 16 patients were excluded,including 8 died during treatment,3 discharged and 5 received palliative care,there were finally 29 patients in the NMES group and 30 in the control group.Within 48 h after ICU admission,the NMES group received NMES 1 h per day,for 7 d in addition to standard rehabilitation intervention.While,the control group were given conventional interventions for rehabilitation.Assessments at baseline and post-treatment included the incidence of ICU-acquired weakness(ICU-AW),Medical Research Council(MRC)score,duration of mechanical ventilation,lengths of ICU and total hospital stays,and activity,thickness and thickening fraction of the diaphragm.Mortality rates and Barthel index(BI)for self-care ability in 1,3 and 6 months after discharge were recorded for follow-up assessments.Results The NMES group had significantly lower incidence of ICU-AW(P<0.05),higher upper and lower limb MRC scores and overall MRC score at ICU discharge(P<0.05),shorter durations of mechanical ventilation,ICU stay,and total hospital stay when compared with the control group(P<0.05).There was no statistical difference in the BI at 1 month post-discharge between the 2 groups,but the indexes at 3 and 6 months were notably higher in the NMES group than the control group(P<0.05).No obvious differences were observed between the 2 groups in terms of diaphragm activity,thickness,or thickening scores at enrollment,ICU discharge,or hospital discharge,nor in mortality rates at 1,3,and 6 months after discharge.

关 键 词：神经肌肉电刺激 急性重症胰腺炎 急性呼吸窘迫综合征 ICU-AW 肌力 膈肌 

分 类 号：R454.1[医药卫生—治疗学] R563.8[医药卫生—临床医学] R576