行动研究法对慢阻肺患者机械通气后获得性衰弱的干预作用研究

Intervention effect of early activity guided by action research method on mechanical ventilation-acquired weakness in elderly COPD patients

目的探讨行动研究法指导四级早期活动对老年慢性阻塞性肺疾病(简称慢阻肺)机械通气患者ICU获得性衰弱(ICU-AW)的干预作用。方法收集92例老年慢阻肺机械通气患者作为观察对象,随机分为2组,每组各46例。对照组给予常规模式的四级早期活动干预,观察组给予行动研究法指导四级早期活动干预。采用医学研究委员会(MRC)评分评价肌力情况。比较对照组和观察组患者ICU-AW发生率、MRC评分、呼吸机使用天数、ICU入住天数、住院总天数、日常生活能力(ADL)评分及并发症发生率。结果与对照组相比,观察组患者转出ICU病房时ICU-AW发生率降低(10.9%vs 28.3%),MRC评分升高(50.45±6.03分vs 46.27±5.12分),呼吸机使用天数、ICU入住天数、住院总天数缩短(3.8±1.3 d vs 5.2±1.9 d,7.6±2.1d vs 10.5±2.8 d,14.4±3.3 d vs 16.9±3.7 d),干预后ADL评分升高(47.55±9.42分vs 36.93±8.01分),且并发症发生率降低(2.2%vs 17.4%),组间比较差异均具有统计学意义(均P<0.05)。结论行动研究法指导四级早期活动能够有效预防老年慢阻肺机械通气患者ICU-AW的发生,缩短机械通气时间及ICU入住时间,提高日常生活能力,降低并发症发生率,临床上值得应用。

Objective To investigate the intervention effect of four stage early activity guided by action research method on ICU-acquired weakness(ICU-AW)in elderly COPD patients with mechanical ventilation.Methods 92 elderly COPD patients with mechanical ventilation were collected as observational objects to be randomly divided into two groups with 46 cases in each group.The control group was intervened with conventional mode of four stage early activity,while the observation group was intervened with four stage early activity guided by action research method.Medical Research Council(MRC)score was employed to assess status of muscle strength.Then,the incidences of ICU-AW,MRC score,days of use of ventilator,ICU treatment,the hospitalization,scores of activity of daily living(ADL)and complications were compared between the two groups.Results In comparison with the control group,the observation group had lower incidence of ICU-AW(10.9%vs 28.3%),higher MRC score(50.45±6.03 points vs 46.27±5.12 points)when moving out of the ICU ward,shorter days of use of ventilator,ICU treatment,hospitalization(3.8±1.3 d vs 5.2±1.9 d,7.6±2.1d vs 10.5±2.8 d,14.4±3.3 d vs 16.9±3.7 d),higher ADL score(47.55±9.42 points vs 36.93±8.01 points)after intervention and lower incidence of complications(2.2%vs 17.4%)with all statistical differences(all P<0.05).Conclusion Four stage early activity guided by action research method can effectively prevent incidence of ICU-AW in elderly COPD patients with mechanical ventilation,and it can shorten time of mechanical ventilation,ICU treatment,improve activity of daily living and reduce incidence of complications.