早期强化康复运动对体外膜肺氧合期间生理参数的影响

Effect of Early Intensive Rehabilitation Exercise on Physiological Parameters During Extracorporeal Membrane Oxygenation

目的探讨早期强化康复训练对行体外膜肺氧合(ECMO)治疗患者呼吸和血液动力学的影响.方法选取2020年1月—2022年6月于本院接受ECMO治疗的患者38例,根据随机数字表法分为两组.对照组(n=18)实施ECMO术后常规康复护理,干预组(n=20)在治疗24 h内进行早期强化康复训练.记录干预组首次训练前及训练后30 min的呼吸、血液动力学参数,在训练第1、3、7天采用医学研究理事会评分(MRC-Score)评估两组患者的肌力,并记录干预期间两组的不良事件发生情况.结果干预组首次训练前的呼吸频率、血氧饱和度、心率、平均动脉压与康复后30 min比较,差异无统计学意义(P>0.05).干预第1、3天,两组的MRC-score评分比较,组间差异无统计学意义(P>0.05);干预第7天,干预组的MRC-score评分为(57.40±1.09)分,高于对照组的(52.00±1.02)分,差异有统计学意义(P<0.05).两组干预期间均未发生不良事件.结论ECMO患者进行早期强化康复训练安全可行,对呼吸和血液动力学参数的影响较小,有助于增加患者肌力,预防早期ICU衰弱的发生.

Objective To investigate the effect of early intensive rehabilitation exercise on respiration and hemodynamics in patients who received extracorporeal membrane oxygenation(ECMO).Methods 38 patients who received ECMO treatment in our hospital from January 2020 to June 2022 were selected and were divided into two groups according to random number table method.The control group(n=18)received routine rehabilitation nursing after ECMO,and the intervention group(n=20)received early intensive rehabilitation exercise within 24 h after treatment.The respiratory and hemodynamic parameters of the intervention group were recorded before and 30 min after the first training.The medical research council scores(MRC-Score)were used to evaluate the muscle strength of patients in both groups at day 1,3 and 7 of training,and the occurrence of adverse events in both groups during the intervention period was recorded.Results There were no significant differences in respirationrate,oxygen saturation,heart rate and mean arterial pressure between the intervention group before and 30 min after first training(P>0.05).On the 1st and 3rd day of intervention,there were no significant differences in MRCscores between the two groups(P>0.05);on the 7th day of intervention,the MRC-score of the intervention group was(57.40±1.09)points,higher than(52.00±1.02)points of the control group,and the difference was statistically significant(P<0.05).No adverse events occurred in both groups during the intervention period.Conclusion Early intensive rehabilitation exercise ECMO patients is safe and feasible,and has little influence on respiratory and hemodynamic parameters,which is helpful to increase muscle strength and prevent early ICU weakness.