早期被动康复训练在老年机械通气患者中的应用

Application Value of Early Passive Rehabilitation Training in Elderly Patients with Mechanical Ventilation

目的观察将早期被动康复训练应用于老年机械通气(mechanical ventilation,MV)患者的临床效果。方法选择2022年1月至2022年6月入住锦州医科大学附属第一医院重症医学科(intensive care unit,ICU)的老年MV患者127例,将患者随机分为观察组64例与对照组63例,对照组在患者清醒可以配合后,由医生进行评估,患者病情相对稳定,可以进行康复训练后,由护士指导患者进行抬腿、伸展等康复训练,每日2次,每次30 min;观察组患者在MV 24 h后,由医生进行评估,患者病情相对稳定,可以进行康复训练后,由康复理疗师对患者进行被动康复训练,每日1次,每次45 min。两组患者的其他治疗与护理基本相同。比较两组患者的MV时间、总住院时间、转出ICU前氧合指数以及英国医学研究理事会(medical research council,MRC)肌力评分、ICU获得性衰弱(ICU-acquired weakness,ICU-AW)发生率、谵妄发生率。结果对照组患者MV时间为(79.63±18.36)h,总住院时间为(11.33±2.91)d,谵妄发生率为52.4%,转出ICU前氧合指数(318.22±24.58),转出ICU前MRC评分(54.22±9.96)分,ICU-AW发生率为38.1%;观察组患者MV时间为(72.20±11.45)h、总住院时间(10.36±1.85)d,谵妄发生率为31.3%,转出ICU前氧合指数(339.10±35.89),转出ICU前MRC评分(57.42±7.68)分,ICU-AW发生率为17.2%;与对照组相比,观察组患者的MV时间、总住院时间、谵妄发生率、ICU-AW发生率均有明显降低,转出ICU前氧合指数以及MRC评分均有明显提升,差异具有统计学意义(P<0.05)。结论将被动康复训练应用于ICU中老年MV患者的早期实践中,可以改善患者肌力,提升氧合指数,降低ICU-AW发生率与谵妄发生率,减少MV时间与总住院时间。

Objective To observe the clinical effect of early passive rehabilitation training on elderly patients with mechanical ventilation(MV).Methods 127 elderly MV patients who were admitted to intensive care unit(ICU)of the First Affiliated Hospital of Jinzhou Medical University from January 2022 to June 2022 were selected.The patients were randomly divided into the observation group(64 cases)and the control group(63 cases).The control group was evaluated by doctors after the patients were awake enough to cooperate.After the patient′s condition was relatively stable enough to undergo rehabilitation training,the nurse instructed the patient to carry out rehabilitation training such as leg lifting and stretching,twice a day for 30 minutes each time;the patients in the observation group were evaluated by doctors after 24 hours of MVS.After the patient′s condition was relatively stable enough to undergo rehabilitation training,the rehabilitation physiotherapist conducted passive rehabilitation training for the patients,once a day for 45 minutes each time.Other treatments and nursing were basically the same in both groups.The MV time,total hospital stay,oxygenation index before transferring out of the ICU,Medical Research Council(MRC)muscle strength score,ICU acquired weakness(ICU-AW)incidence and delirium incidence were compared between the two groups.Results In the control group,the MV time was(79.63±18.36)h,the total hospitalization time was(11.33±2.91)d,the delirium incidence rate was 52.4%,the oxygenation index before transferring out of ICU was(318.22±24.58),the MRC score before transferring out of ICU was(54.22±9.96)points,and the ICU-AW incidence rate was 38.1%;in the observation group,the MV time was(72.20±11.45)h,the total hospitalization time was(10.36±1.85)d,the delirium incidence rate was 31.3%,the oxygenation index before transferring out of ICU was(339.10±35.89),the MRC score before transferring out of ICU was(57.42±7.68)points,and the ICU-AW incidence rate was 17.2%;compared with the control group,the MV time,total hospitalization time,delirium incidence,ICU-AW incidence of the patients in the observation group were significantly decreased,there was a significant improvement in oxygenation index and MRC score before transferring out of ICU,and the difference is statistically significant(P<0.05).Conclusion Applying passive rehabilitation training to the early practice of elderly MV patients in the ICU can improve patient muscle strength,increase oxygenation index,reduce the incidence of ICU-AW and delirium,and reduce MV time and total hospital stay.