基于Roy适应模式的早期活动专项培训在重症监护病房机械通气患者中的应用效果

Application effect of special training for early activity based on Roy adaptation mode in ICU patients with mechanical ventilation

目的观察基于Roy适应模式的早期活动专项培训在重症监护病房(ICU)机械通气患者中的应用效果及对ICU获得性衰弱(ICU-AW)和生存质量的影响。方法选择2017年1～12月新疆医科大学第一附属医院重症医学科接受治疗ICU机械通气患者84例,按照随机数字表法分为对照组(42例)和观察组(42例)。对照组给予常规模式的早期活动专项培训,观察组给予基于Roy适应模式的早期活动专项培训。分别采用医学研究委员会(MRC)评分和世界卫生组织生存质量测定量表简表(WHO QOL-BREF)评价肌力情况和生存质量。比较两组患者呼吸机使用天数、ICU入住天数、住院总天数、ICU-AW(ICU获得性衰弱)发生率、MRC评分及生存质量。结果观察组患者呼吸机使用天数、ICU入住天数、住院总天数少于对照组,差异有统计学意义(P <0.05)。转出ICU病房时,与对照组比较,观察组患者ICU-AW发生率降低,MRC评分升高,反映生存质量的生理、心理、社会、环境方面评分及总分升高,差异有统计学意义(P <0.05)。结论基于Roy适应模式的早期活动专项培训在ICU机械通气患者中应用效果良好,能够缩短机械通气及ICU入住时间,降低ICU-AW发生率,提高生存质量,临床上值得应用。

Objective To observe the application effect of special training for early activity based on Roy adaptation mode in Intensive Care Unit （ICU） patients with mechanical ventilation and its influences on ICU-acquired weakness （ICU-AW） and quality of life. Methods From January to December 2017, in Department of Critical Care Medicine, NO.1 Hospital Affiliated to Xinjiang Medical University, 84 ICU patients with mechanical ventilation who received therapy were selected, according to random number table method, they were divided into control group and observation group, with 42 cases in each group. The control group was given conventional mode of special training for early activity, while the observation group was given special training for early activity based on Roy adaptation mode, Medical Research Council （MRC） score and brief scale of WHO quality of life （WHO QOL-BREF） were employed to assess muscle strength and life of quality respectively. Then, days of use of ventilator, ICU treatment, the hospitalization, incidences of ICU-AW, MRC score and life of quality in the two groups were compared. Results The days of using ventilator, ICU treatment and hospitalization in the observation group were less than the control group, the differences were statistically significant （P 〈 0.05）. When moving out of the ICU ward, compared with the control group, the observation group had lower incidence of ICU-AW and higher MRC scores, the differences were statistically significant （P 〈 0.05）. As to life of quality, scores of physiology, psychology, society, circumstance and total scores that reflected life of quality in the observation group were higher than the control group when moving out of ICU ward, the differences were statistically significant （P 〈 0.05）. Conclusion Special training for early activity based on Roy adaptation mode has well application effect on ICU patients with mechanical ventilation. It can shorten time of mechanical ventilation, ICU treatment, reduce incidence of ICU-AW and improve quality of life.