下肢踏车式被动训练在机械通气患者早期康复中的应用

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

目的观察机械通气(mechanical ventilation,MV)患者早期应用下肢踏车式被动康复训练的临床效果。方法选择2023年6月至2023年7月在锦州医科大学附属第一医院重症医学科(intensive care unit,ICU)二病区确诊的MV患者78例,将患者随机分为观察组39例与对照组39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,可以进行康复训练由护士指导患者进行抬腿、伸展等康复训练,每天2次,每次45 min;观察组给予患者双下肢踏车式被动康复训练,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,根据使用说明对患者进行被动踏车训练,每天2次,每次45 min。两组患者的其他治疗与护理基本相同。比较两组患者进行下肢被动训练3 d与转出ICU前的氧合指数、MV时间、总住院时间、再插管率、转出ICU前英国医学研究理事会肌力评分(medical research council,MRC)、ICU获得性衰弱(ICU-acquired weakness,ICU-AW)发生率。结果与对照组相比,观察组患者干预后3 d、转出ICU前氧合指数均有明显升高,观察组患者MV时间、总住院时间及再插管率均有明显降低,观察组患者转出ICU前MRC肌力评分有明显升高,ICU-AW发生率有明显降低,差异具有统计学意义(P<0.05)。结论将下肢踏车式被动训练应用于ICU中MV患者的早期康复实践中,可以改善患者肌力,降低ICU-AW发生率,改善氧合指数,降低再插管率,减少MV时间与总住院时间。

Objective To observe the clinical effect of early treadmill passive rehabilitation training on patients with mechanical ventilation(MV).Methods 78 MV patients admitted to the second ward of Intensive Care Unit(ICU)of the Second Affiliated Hospital of Jinzhou Medical University from June 2023 to July 2023 were selected,the patients were randomly divided into observation group(39 cases)and control group(39 cases).The control group was evaluated by the doctor after the patient was awake and able to cooperate.The patient′s condition was relatively stable.After rehabilitation training,the nurse guided the patient to carry out rehabilitation training such as leg lifting and stretching,twice a day,for 45 minutes each time;in the observation group,patients were given passive treadmill rehabilitation training for both lower limbs.After 24 hours of MV,the doctor assessed the patient′s condition was relatively stable.After rehabilitation training,patients were given passive treadmill training according to the instructions twice a day,for 45 minutes each time.The other treatment and nursing of the two groups were basically the same.The oxygenation index after 3 days of lower limb passive training and before being transferred out of ICU,and the MV time,total hospital stay,reintubation rate,muscle strength score of the Medical Research Council(MRC)before being transferred out of the ICU,and the incidence of ICU acquired weakness(ICU-AW)were compared between these two groups.Results Compared with the control group,the oxygenation index of patients in the observation group increased significantly 3 days after intervention and before being transferred out of ICU,the MV time,total hospital stay and reintubation rate in the observation group were significantly reduced,the MRC muscle strength score of patients in the observation group increased significantly before being transferred out of ICU,the incidence of ICU-AW decreased significantly,and the difference was statistically significant(P<0.05).Conclusion The application of lower extremity treadmill passive training in the early rehabilitation practice of MV patients in ICU can improve the muscle strength of patients,reduce the incidence of ICU-AW,improve the oxygenation index,reduce the reintubation rate,and reduce the MV time and total hospital stay.