阶梯式早期功能康复策略对格林巴利机械通气患者预后的影响

The Influence of the Serious Guillain-Barre Syndrome Patients’ Prognosis Who Were Used Mechanical Ventilation When Applied the early functional rehabilitation strategy: A controlled study

目的探讨阶梯式早期运动和呼吸功能康复对重症格林巴利综合征机械通气患者预后的影响。方法选取2014年3月-2017年12月在我科行ICU行机械通气治疗的67例重症GBS患者(ASMAN亚型)为研究对象,采用随机数字分组的方法进行研究,分为观察组33例,对照组34例。对照组采用ICU常规及机械通气护理,观察组在对照组基础上引入阶梯式早期运动和呼吸功能康复策略。观察两组患者机械通气时间、肌力评定、生活能力评分、急性生理与慢性健康评分、ICU住院时间、总住院时间及相关并发症发生情况。结果干预后观察组的机械通气时间较对照组缩短(P<0.01),肌力及生活能力评定均优于对照组(P<0.05),急性生理与慢性健康评分低于对照组(P<0.01),ICU住院时间及总住院时间均短于对照组(P<0.05)。两组患者在VAP、深静脉血栓、压疮及死亡的发生率上差异均无统计学意义(P>0.05)。结论阶梯式早期运动和呼吸功能康复策略可以缩短重症格林巴利综合征机械通气患者机械通气时间,促进肌力和生活能力恢复,减少住院时间,有效促进患者康复。

Objective To discuss the effect of applied the early functional rehabilitation strategy on the change of the serious Guillain-Barre Syndrome(GBS)’prognostic by using mechanical ventilation.Methods Random digit grouping were applied in this study.67 serious GBS patients were involved.There were 34 patients in the controlled group and 33 patients in the intervention group.The controlled group was applied the normal ICU mechanical ventilation care while the intervention group was applied early functional rehabilitation strategy on this basis.These data were observed:duration of mechanical ventilation,duration of ICU hospital stay,the total hospital stay;MRC-score,APACHEⅡ,Barthel ADL Index;the occurrence of ventilator-associated pneumonia(VAP),pressure sores,deep venous thrombosis(DVT)and death.Results There was no significant statistic difference between the basic data of two groups.It showed that the two groups had comparability.When the patients went out ICU there was significant statistic difference between the two groups at MRC-score(P<0.05),APACHEⅡ(P<0.01),Barthel ADL Index(P<0.01)scores.The intervention group was better than the control group in these respects.There was significant statistic difference between the two groups at the duration of mechanical ventilation(P<0.01),duration of ICU hospital stays(P<0.01)and the total hospital stay(P<0.05).The intervention group was shorter than the control group in these respects.There was no statistic difference in the occurrence of VAP,pressure sores,DVT and death(P>0.05).Conclusion Early functional rehabilitation strategy can improve the prognosis of the serious GBS patients who were used mechanical ventilation.However,the influence of complication needs to be observed in bigger data in the future.