认知功能正常的胰腺炎患者解除约束对ICU获得性衰弱、四肢肌力、拔管率的影响

The impact of removing restraint on ICU acquired weakness,limb muscle strength and unplanned extubation in pancreatitis patients with normal cognitive function

目的探讨认知功能正常的胰腺炎患者解除约束对ICU获得性衰弱(ICU-AW)、四肢肌力、拔管率的影响。方法选择2017年2月至2018年11月入住中南大学湘雅医院重症医学科认知功能正常的80例胰腺炎患者,按照随机数字表法分为试验组和对照组各40例。对照组采取常规护理及约束,试验组在对照组基础上解除约束。比较2组患者英国医学研究委员会(MRC)评分、ICU-AW发生率、拔管率。结果试验组干预前和干预后第3天、第7天、第10天MRC评分别为(55.1 ± 4.2)、(54.2 ± 4.6)、(53.4 ± 4.3)、(52.3 ± 4.8)分,对照组分别为(53.8 ± 5.6)、(52.0 ± 6.2)、(49.7 ± 6.2)、(48.7 ± 5.7)分,试验组MRC评分明显高于对照组,第7天、第10天2组MRC评分比较差异有统计学意义(t=3.012、3.060,P<0.05);试验组ICU-AW发生率为25.0%(10/40),对照组为37.5%(15/40),试验组低于对照组,但差异无统计学意义(χ2=1.455,P>0.05)。2组患者均未出现非计划性拔管。结论对认知功能正常的胰腺炎患者解除约束能减缓肌力下降趋势但对于ICU-AW发生率无积极影响。

Objective To investigate the impact of removing restraint on intensive care unit acquired weakness(ICU-AW), muscle strength and the incidence of extubation in patients with pancreatitis but normal cognitive function. Methods Eighty patients with pancreatitis but normal cognitive function hospitalized from February 2017 to November 2018 were divided into experimental group (40 cases) and control group (40 cases) by random digits table method. The control group received routine care and restraint, while the experimental group was removed from restraint compared with the control group. The Medical Research Council (MRC) score, incidence rate of ICU-AW, and extubation rate were compared between the two groups. Results The MRC scores of the experimental group before intervention, on 3rd, 7th and 10th day were (55.1±4.2),(54.2±4.6),(53.4±4.3), and (52.3±4.8) respectively. The MRC scores before the intervention, on the 3rd, 7th, and 10th day in the control group were (53.8±5.6),(52.0±6.2),(49.7±6.2), and (48.7±5.7) respectively. The MRC scores of the experimental group were significantly higher than those of the control group. The difference of MRC scores between the two groups was statistically significant on the 7th and 10th day(t=3.012, 3.060, P<0.05). The incidence of ICU-AW was 25.0%(10/40) in the experimental group and 37.5%(15/40) in the control group. The experimental group was lower than the control group, but the difference was not statistically significant (χ2=1.455, P>0.05). There was no unplanned extubation in both groups. Conclusions The removal of restraint in patients with pancreatitis but normal cognitive function can slow down the decline in muscle strength but has no positive impact on the incidence rate of ICU-AW.