床旁轮椅端坐活动在急性呼吸窘迫综合征机械通气病人中的应用  

Application of bedside wheelchair sitting activity in mechanically ventilated patients with acute respiratory distress syndrome

作　　者：张娜 夏慧 张云磊 ZHANG Na;XIA Hui;ZHANG Yunlei(Department of Intensive Care Medicine,Huai′an First People′s Hospital,Jiangsu Nanjing 223300,China)

机构地区：[1]江苏省淮安市第一人民医院重症医学科,223300

出　　处：《蚌埠医学院学报》2024年第11期1495-1498,1503,共5页Journal of Bengbu Medical College

基　　金：江苏省自然科学基金面上项目(BK20211136)。

摘　　要：目的:探讨床旁轮椅端坐活动在急性呼吸窘迫综合征(ARDS)机械通气病人中的应用价值。方法:采用简单随机抽样法,选择重症医学科收治102例ARDS机械通气病人作为研究对象,采用随机数字表法分为对照组和观察组,各51例。对照组实施常规早期康复运动,观察组实施床旁轮椅端坐活动。观察2组训练开始时和训练1、3、5 d及出院前英国医学研究理事会(MRC)肌力评分、不良事件发生率、临床结局。结果:训练开始时,2组病人MRC评分差异无统计学意义(P>0.05);训练1、3、5 d及出院前,2组MRC评分均较训练开始时降低,且观察组均高于对照组(P<0.05~P<0.01)。2组病人不良事件发生率差异无统计学意义(P>0.05)。观察组病人通气时间、ICU住院时间、出院时急性生理与慢性健康评分、获得性肌无力发生率均低于对照组(P<0.05~P<0.01),脱机30 min氧合指数高于对照组(P<0.05)。结论:床旁轮椅端坐活动有利于ARDS病人机械通气治疗期间的肌力水平保持,降低获得性肌无力发生风险,改善临床结局。Objective:To investigate the application value of bedside wheelchair sitting activity in mechanically ventilated patients with acute respiratory distress syndrome(ARDS).Methods:Using the simple random sampling method,102 mechanically ventilated patients with ARDS admitted to the intensive care department were selected as the study subjects,and divided into control group and observation group,51 cases in each group.The control group performed routine early rehabilitation exercise,and the observation group performed bedside wheelchair sitting activity.Body strength scores,incidence of adverse events,and clinical outcome of the British Medical Research Council(MRC)muscle strength score at begining of training,1,3 and 5 d of training,and before discharge were recorded.Results:At the beginning of training,there was no significant difference in MRC scores between the two groups(P>0.05).At 1,3,and 5 d of training and before discharge,the MRC scores of the two groups were lower than those at the beginning of training,which were higher in the observation group than that in the control group(P<0.05 to P<0.01).There was no significant difference in the incidence of adverse events between the two groups(P>0.05).The duration of ventilation,length of ICU stay,acute physiological and chronic health evaluationⅡscore at discharge,and intensive care unit acquired weakness were all lower than those of the control group(P<0.05 to P<0.01),and the 30 min oxygenation index was higher than the control group(P<0.05).Conclusions:Bedside wheelchair sitting activity is beneficial to the maintenance of muscle strength during mechanical ventilation in ARDS patients,reduce the risk of acquired weakness,and improve clinical outcomes.

关 键 词：急性呼吸窘迫综合征 机械通气 床旁轮椅端坐活动 获得性肌无力 

分 类 号：R563.8[医药卫生—呼吸系统] R473[医药卫生—内科学]