危重症患儿早期循序渐进运动方案的构建及应用

Construction and preliminary application of early progressive exercise program for critically ill children

目的 构建危重症患儿早期循序渐进运动方案并探讨其初步应用效果。方法 以儿童重症监护后综合征框架为理论基础,在文献回顾的基础上,于2021年1月—2月开展2轮专家咨询,构建危重症患儿早期循序渐进运动方案。于2021年3月在上海市某三级甲等儿童医院收治的危重症患儿中进行初步应用,试验组、对照组各5例,评价方案的安全性及干预效果。结果 第2轮专家咨询中,有效问卷回收率为100%,专家权威系数为0.82,各条目的重要性评分及可行性评分均>3.5分,变异系数均<0.25,肯德尔和谐系数为0.312~0.330(均P<0.001)。危重症患儿早期循序渐进运动方案包括3个一级条目、10个二级条目和28个三级条目。初步应用结果显示,方案实施过程中未发生不良事件,试验组干预前后肱二头肌横截面积差值小于对照组,差异具有统计学意义(P=0.047)。结论 该研究构建的危重症患儿早期循序渐进运动方案具有科学性、可靠性且安全可行,但还需扩大样本量进一步验证其临床应用效果。

Objective To construct an early progressive exercise program for critically ill children,and to verify its effect. Methods Combining the theoretical framework derived from post-intensive care syndrome in pediatrics(PICS-p) and literature review,under 2 rounds of expert consultations from January to February 2021,an early progressive exercise program was established for critically ill children. To evaluate the safety and intervention effects of the program,the preliminary application was carried out in 5 critically ill children admitted to a tertiary children’s hospital in Shanghai in March 2021. Results The active and authority coefficient were 100% and 0.82;the importance and feasibility score of each item were all >3.5;the variation coefficients were <0.25;the Kendal harmony coefficients were between 0.312 and 0.330(P<0.001). The final draft of the early progressive exercise program for critically ill children included 3 first-level items,10 second-level items,and 28 third-level items. The preliminary application results showed that no adverse events occurred during the implementation of the program,and the difference of biceps brachii cross-sectional area in the experimental group was smaller than that in the control group(P=0.047). Conclusion The early progressive exercise program for critically ill children is scientific,reliable,safe,and feasible,but its clinical effect needs to be further verified by a larger sample size.