分级康复训练对ICU机械通气患者肌力衰弱、压疮的影响

Effect of graded rehabilitation training on muscle weakness and pressure sore of ICU patients through mechanical ventilation

目的:探讨分级康复训练对ICU机械通气患者肌力衰弱、压疮的影响。方法:选取我院ICU机械通气患者114例为研究对象,随机将其等分为对照组与观察组,对照组给予ICU常规护理,予以四肢被动活动、功能训练;观察组采用四级早期活动与康复训练,直至患者出科或出院。干预结束后采用肌力评定法(MRC-score)评估肌力及Barthel指数,统计患者住院期间获得性肌无力(ICU-AW)、呼吸机相关性肺炎(VAP)及压疮发生情况,记录其机械通气时间、ICU住院时间。结果:出院时对照组肌力评估2~5级依次是7例、17例、25例、8例,显著低于观察组4例、6例、33例、14例,差异有统计学意义(P<0.05);出院时对照组Barthel指数(84.50±8.70)分,均显著低于观察组(92.30±10.50)分,差异有统计学意义(P<0.05);对照组机械通气、ICU住院时间显著高于观察组,差异有统计学意义(P<0.05);对照组ICU-AW发生例数显著高于观察组(P<0.05),但两组VAP、压疮发生率比较差异无统计学意义(P>0.05)。结论:分级康复训练可有效提升ICU机械通气患者肌力,避免ICU内获得性肌力衰弱及压疮发生,有利于患者康复。

Objective:To explore the effect of graded rehabilitation training on muscle weakness and pressure sore of ICU patients through mechanical ventilation.Methods:To select114cases of ICU patients through mechanical ventilation from our hospital and randomly divide them into control group and observation group.Control group was given ICU routine nursing and arms and legs were given passive activity and functional training.Observation group adopted four stage early activity and rehabilitation training until they left the department or hospital.Apply muscle force rating method(MRC-score)to evaluate muscle force and Barthel index after intervention,and count the occurrence conditions of acquired muscle weakness(ICU-AW),ventilator-associated pneumonia(VAP)and pressure sore for patients during hospital stays,and record their mechanical ventilation time,hospital stays in ICU.Results:Evaluation of2-5grade of muscle force for patients in control group was successively7cases,17cases,25cases and8cases when leaving hospital,which was obviously lower than that in observation group of4cases,6cases,33cases and14cases,and the difference was statistically significant(P<0.05).Barthel index score was(84.50±8.70)in control group when leaving hospital,which was obviously lower than that in observation group of(92.30±10.50),and the difference was statistically significant(P<0.05).Mechanical ventilation time and ICU hospital stays in control group were obviously higher than those in observation group,and the difference was statistically significant(P<0.05).Occurrence cases of ICU-AW in control group was obviously higher than that in observation group(P<0.05),but compare the occurrence rate VAP and pressure sore between the two groups,and the difference was not statistically significant(P>0.05).Conclusion:Graded rehabilitation training could effectively increase muscle force of ICU patients through mechanical ventilation,and avoid the occurrence of ICU acquired muscle weakness and pressure sore and be helpful for patients’recovery.