经皮神经肌肉电刺激对COPD机械通气患者ICU-AW的预防效果

Effect of transcutaneous neuromuscular electrical stimulation on prevention of intensive care unit-acquired weakness in chronic obstructive pulmonary disease patients with mechanical ventilation

目的评价经皮神经肌肉电刺激对慢性阻塞性肺疾病(COPD)机械通气患者ICU获得性肌无力(ICU-AW)的预防效果.方法采用前瞻性随机对照研究方法,选择2017年10月至2018年10月湖南医药学院第一附属医院综合重症加强治疗病房(ICU)收治的60例18~85岁、接受机械通气治疗的COPD患者.按随机数字表法将患者分为对照组(n=30)和干预组(n=30).两组均给予常规治疗和护理,干预组在此基础上于入科24 h后即开始对四肢进行经皮神经肌肉电刺激治疗(每日2次、每次30 min),直至转出ICU.比较两组患者入ICU 7 d及出ICU时医学研究委员会肌力评分(MRC-Score)、握力、ICU-AW发生率,出ICU时改良Barthel评分,以及机械通气时间、ICU住院时间、总住院时间的差异.结果最终对照组和干预组分别有29例和27例患者完成研究.两组患者性别、年龄、入ICU前2周Barthel评分、入ICU时体重指数和急性生理学与慢性健康状况评分Ⅱ(APACHEⅡ)差异均无统计学意义.入ICU 7 d时,两组患者MRC-Score、握力、ICU-AW发生率比较差异均无统计学意义.与对照组比较,干预组出ICU时MRC-Score、握力和Barthel评分均明显升高〔MRC-Score(分):55.97±8.43比46.32±7.36,握力(kg):33.46±11.62比27.42±9.64,Barthel评分(分):46.04±5.46比42.13±3.32,均P<0.05〕,ICU-AW发生率显著降低〔7.4%(2/27)比31.0%(9/29),P<0.05〕,机械通气时间、ICU住院时间和总住院时间均明显缩短〔机械通气时间(d):5.12±2.01比7.24±4.35,ICU住院时间(d):8.34±2.36比10.45±2.62,总住院时间(d):13.21±2.21比15.38±3.67,均P<0.05〕.结论经皮神经肌肉电刺激治疗可有效提高COPD机械通气患者的肌力,减少ICU-AW的发生.

Objective To evaluate the effect of transcutaneous neuromuscular electrical stimulation on prevention of intensive care unit-acquired weakness (ICU-AW) in chronic obstructive pulmonary disease (COPD) patients with mechanical ventilation. Methods A prospective randomized controlled study was conducted. Sixty COPD patients aged 18-85 years old who were accepted mechanical ventilation therapy admitted to general intensive care unit (ICU) of the First Affiliated Hospital of Hunan University of Medicine from October 2017 to October 2018 were enrolled. Patients were divided into control group (n = 30) and intervention group (n = 30) by random number table method. All patients were accepted routine treatment, and on this basis, the intervention group was applied transcutaneous neuromuscular electrical stimulation on the extremities (twice a day, 30 minutes each time) after 24 hours of admission until ICU discharge. The Medical Research Council muscle strength score (MRC-Score), grip strength, incidence of ICU-AW on the 7th day after admission and on the day of ICU discharge;modified Barthel index score on the day of ICU discharge;and duration of mechanical ventilation, the length of ICU stay, and the length of hospital stay were compared between the two groups. Results Twenty-nine and 27 patients in the control group and the intervention group respectively finally completed the study in dividually. There was no significant difference in gender, age, Barthel index score before 2 weeks of ICU admission, body mass index or acute physiology and chronic health evaluation Ⅱ(APACHEⅡ) in ICU between the two groups. There was no significant difference in the MRC-Score, grip strength or incidence of ICU-AW on the 7th day after ICU admission between the two groups. Compared to the control group, the MRC-Score, grip strength and Barthel index score in the intervention group were significantly increased [MRC-Score: 55.97±8.43 vs. 46.32±7.36, grip strength (kg): 33.46±11.62 vs. 27.42±9.64, Barthel index score:46.04±5.46 vs. 42.13±3.32, all P < 0.05], the incidence rate of ICU-AW was significantly decreased [7.4%(2/27) vs. 31.0%(9/29), P < 0.05], and duration of mechanical ventilation, the length of ICU stay, the length of hospital stay were significantly shortened [duration of mechanical ventilation (days): 5.12±2.01 vs. 7.24±4.35, the length of ICU stay (days): 8.34±2.36 vs. 10.45±2.62, the length of hospital stay (days): 13.21±2.21 vs. 15.38±3.67, all P < 0.05]. Conclusion Transcutaneous neuromuscular electrical stimulation can effectively improve the muscle strength of COPD patients with mechanical ventilation and reduce the incidence of ICU-AW.