悬吊运动治疗对机械通气患者呼吸机相关膈肌功能障碍的干预效果

Effect of sling exercise therapy on ventilator-induced diaphragm dysfunction in patients with mechanical ventilation

目的探讨悬吊运动治疗对机械通气患者呼吸机相关膈肌功能障碍(VIDD)的干预效果,为VIDD的防治提供参考。方法采用前瞻性随机对照试验方法,便利抽样法选择2022年7月至2023年7月广州市红十字会医院收治的74例机械通气患者,按照随机数字表法分为试验组和对照组,每组37例。2组患者均给予常规护理,在此基础上对照组实施早期康复锻炼,试验组实施悬吊运动治疗。评价2组患者干预不同时间膈肌功能、呼吸功能以及终点事件的差异。结果最终试验组纳入34例,其中男22例,女12例,年龄(55.50±12.03)岁;对照组纳入36例,其中男25例,女11例,年龄(54.78±12.81)岁。2组患者干预前膈肌功能、呼吸功能比较差异均无统计学意义(均P>0.05)。干预7 d,试验组患者膈肌移动度、膈肌厚度分数分别为(1.59±0.21)cm、(45.90±5.20)%,高于对照组患者的(1.49±0.21)cm、(42.78±5.51)%,差异均有统计学意义(t=2.13、2.44,均P<0.05)。干预5、7 d试验组患者浅快呼吸指数分别为(81.47±6.97)、(77.29±8.91)次·min^(-1)·L^(-1),低于对照组患者的(88.36±9.04)、(84.67±9.64)次·min^(-1)·L^(-1),干预3、5、7 d试验组患者氧合指数分别为(230.79±44.79)、(241.59±23.79)、(258.56±23.09)mmHg(1 mmHg=0.133 kPa),高于对照组患者的(197.25±21.21)、(212.72±21.81)、(242.75±24.37)mmHg,差异均有统计学意义(t值为2.78~5.30,均P<0.05)。试验组患者机械通气时间、ICU住院时间分别为(225.29±47.31)h、(12.47±3.71)d,少于对照组患者的(260.53±56.32)h、(14.64±4.53)d,差异均有统计学意义(t=2.83、2.18,均P<0.05)。试验组患者VIDD发生率为5.9%(2/34),低于对照组患者的22.2%(8/36),试验组患者脱机成功率为91.2%(31/34),高于对照组患者的72.2%(26/36),差异均有统计学意义(χ^(2)=4.18、4.15,均P<0.05)。结论悬吊运动治疗可提高机械通气患者膈肌功能和呼吸功能,缩短机械通气时间和ICU住院时间,并有效预防VIDD的发生。

Objective To investigate the intervention effect of sling exercise therapy on ventilator-induced diaphragm dysfunction(VIDD)in patients with mechanical ventilation,and to provide the reference for prevention and treatment of VIDD.Methods By a prospective randomized controlled study method,a total of 74 mechanical ventilation patients in Guangzhou Red Cross Hospital from July 2022 to July 2023 were convenient selected,they were divided into the experimental group and the control group according to the random number table method with 37 cases in each group.Both groups were given routine nursing care,the control group carried out early rehabilitation exercise,the experimental group implemented sling exercise therapy.The diaphragm function,respiratory function after the different time of intervention,and outcome events were compared between two groups.Results Finally,the experimental group included 34 cases,22 males and 12 females,aged(55.50±12.03)years old.The control group included 36 cases,25 males and 11 females,aged(54.78±12.81)years old.There was no significant difference in the diaphragm function,respiratory function before intervention(all P>0.05).After 7 d of intervention,the diaphragmatic excursion,diaphragm thickening fraction were(1.59±0.21)cm,(45.90±5.20)%in the experimental group,which were higher than those in the control group(1.49±0.21)cm,(42.78±5.51)%,the differences were statistically significant(t=2.13,2.44,both P<0.05).After 5,7 d of intervention,the rapid shallow breathing index was(81.47±6.97),(77.29±8.91)times.min^(-1).L^(-1) in the experimental group,which were lower than those in the control group(88.36±9.04),(84.67±9.64)times.min^(-1).L^(-1);after 3,5,7 d on intervention,the oxygenation index was(230.79±44.79),(241.59±23.79),(258.56±23.09)mmHg(1 mmHg=0.133 kPa)in the experimental group,which were higher than those in the control group(197.25±21.21),(212.72±21.81),(242.75±24.37)mmHg,the differences were statistically significant(t values were 2.78-5.30,all P<0.05).The mechanical ventilator time and the length of stay in ICU were(225.29±47.31)h,(12.47±3.71)d in the experimental group,which were lower than those in the control group(260.53±56.32)h,(14.64±4.53)d,the differences were statistically significant(t=2.83,2.18,both P<0.05).The incidence rate of VIDD was 5.9%(2/34)in the experimental group,which was lower than that in the control group 22.2%(8/36),and the weaning success rate was 91.2%(31/34)in the experimental group,which was higher than that in the control group 72.2%(26/36),the differences were statistically significant(χ^(2)=4.18,4.15,both P<0.05).Conclusions Sling exercise therapy can effectively promote diaphragm function and respiratory function,shorten mechanical ventilator time and the length of stay in ICU of patients with mechanical ventilation,and reduce the occurrence of VIDD.