一体化康复干预下机械通气时间与膈肌功能恢复的关系研究  

The relationship between mechanical ventilation time and diaphragm function recovery under integrated rehabilitation intervention

作　　者：骆宁[1] 李寅[1] 朱辰林 杨磊 林竹[1] 高红梅[1] 李红洁[1] 赵秀宝[1] LUO Ning;LI Yin;ZHU Chen-lin(Department of Critical Care Medicine,Tianjin First Central Hospital,Tianjin 300192,China)

机构地区：[1]天津市第一中心医院,天津300192 [2]南开大学一中心临床学院,天津300071 [3]天津市北辰医院,天津300400

出　　处：《中国中西医结合外科杂志》2025年第1期26-29,共4页Chinese Journal of Surgery of Integrated Traditional and Western Medicine

基　　金：天津市卫生健康科技项目(TJWJ2022XK023);天津市医学重点学科建设项目(TJYXZDXK-013A);天津市科技计划项目(21JCYBJC00090);河北省中医药管理局科研计划项目(T2025009)。

摘　　要：目的:探讨一体化康复对重症监护室(ICU)机械通气患者膈肌功能的影响。方法:选择2023年5月—2023年12月天津市第一中心医院重症医学科收治的气管插管及机械通气患者60例为研究对象,均分为对照组和一体化康复治疗组,对照组采用我科制定的ICU患者分级护理细化标准进行主动及被动运动,一体化康复治疗组采用一体化康复模式开展早期重症康复干预。应用床旁超声监测两组患者入院第1、3、5天及撤机前的膈肌移动度及膈肌厚度,检测并比较两组患者的机械通气时间、住ICU时间及总住院时间。结果:入住ICU的机械通气患者均会出现不同程度的膈肌萎缩和移动度减低,这种变化随机械通气时间延长而愈发严重,但在患者撤机前有所恢复。与对照组比较,一体化康复治疗组患者的膈肌移动度和膈肌厚度恢复效果更好;两组患者机械通气时间差异无统计学意义(P>0.05);一体化康复治疗组患者的ICU住院时间和总住院时间比对照组明显缩短,差异具有统计学意义(P <0.05)。结论:对机械通气患者实施一体化康复治疗可以有效改善其膈肌萎缩和膈肌移动度减低,并可以缩短患者住ICU时间和住院时间。Objective To explore the relationship between integrated rehabilitation and diaphragmatic function in ICU patients undergoing mechanical ventilation.Methods Patients undergoing tracheal intubation and mechanical ventilation admitted to the Department of Critical Care Medicine,Tianjin First Central Hospital from May 2023 to December 2023 were selected as study subjects and divided into an observation group and a control group.The control group received active and passive exercises based on the detailed grading nursing standards for ICU patients formulated by our department,while the observation group underwent early critical rehabilitation intervention using an integrated rehabilitation model.The prognosis(ICU stay,duration of mechanical ventilation,and total hospital stay) of the two groups was compared.Bedside ultrasound was used to monitor diaphragmatic excursion and diaphragmatic thickness on the 1st,3rd,5th day of admission,and before ventilator withdrawal in both groups.Results Patients in the ICU on mechanical ventilation all experience varying degrees of diaphragm atrophy and reduced mobility,which worsen with prolonged ventilation but recover somewhat before extubation.Compared to the control group,patients in the integrated rehabilitation therapy group showed better recovery in diaphragm mobility and thickness;there was no statistically significant difference in the duration of mechanical ventilation between the two groups(P >0.05).The ICU stay and total hospital stay were significantly shorter in the integrated rehabilitation therapy group compared to the control group,with the difference being statistically significant(P <0.05).Conclusion Integrated rehabilitation therapy can effectively improve the prognosis of patients undergoing mechanical ventilation and reduce diaphragmatic dysfunction.

关 键 词：重症监护室 一体化康复 机械通气 膈肌 

分 类 号：R493[医药卫生—康复医学]