重症机械通气患者早期个体化康复的效果

doi:10.3969/j.issn.1006-9771.2022.06.013

《中国康复理论与实践》 ›› 2022, Vol. 28 ›› Issue (6): 710-715.doi: 10.3969/j.issn.1006-9771.2022.06.013

重症机械通气患者早期个体化康复的效果

毛晶^1a,唐晓晓^1a,郑瑶^1b,张金牛^1a,阚秀丽^1a,吴建贤^1a()

1.安徽医科大学第二附属医院,a.康复医学科,b.重症监护室二病区,安徽合肥市 230601

收稿日期:2021-10-25 修回日期:2022-05-16 出版日期:2022-06-25 发布日期:2022-07-05
通讯作者: 吴建贤 E-mail:ay2fyjianxianwu@126.com
作者简介:毛晶(1984-),男,汉族,安徽萧县人,硕士,主治医师,主要研究方向：神经重症康复。|吴建贤(1956-),女,汉族,安徽歙县人,教授,博士生导师,主任医师,主要研究方向：神经康复与治疗。
基金资助:
安徽医科大学校科研基金项目(2018xkj049)

Effect of early individualized rehabilitation on patients with severe mechanical ventilation

MAO Jing^1a,TANG Xiaoxiao^1a,ZHENG Yao^1b,ZHANG Jinniu^1a,KAN Xiuli^1a,WU Jianxian^1a()

1. a. Department of Rehabilitation Medicine, b. Intensive Care Unit, the Second Affiliated Hospital of Anhui Medical University, Hefei, Anhui 230601, China

Received:2021-10-25 Revised:2022-05-16 Published:2022-06-25 Online:2022-07-05
Contact: WU Jianxian E-mail:ay2fyjianxianwu@126.com
Supported by:
Scientific Research Fund Project of Anhui Medical University(2018xkj049)

摘要/Abstract

摘要：

目的探讨早期个体化康复治疗对重症机械通气患者的影响。方法 2019年3月至2020年2月,安徽医科大学第二附属医院重症监护室住院并需要机械通气治疗的患者36例,随机数字表法分为对照组(n = 18)和康复组(n = 18)。所有患者入院24 h内完成康复评估,包括临床评估、意识状态和肌力评估。对照组采用重症监护常规治疗,包括原发病的对症治疗、营养支持、良肢位摆放以及四肢主被动运动等。康复组增加早期个体化康复治疗,根据每个患者具体评估情况进行四肢主被动运动、转移训练、物理因子治疗、呼吸肌训练等。比较两组机械通气时间,ICU住院时间,住院总费用,Richmond躁动-镇静评分(RASS),急性生理与慢性健康评分Ⅱ(APACHEⅡ),以及肿瘤坏死因子(TNF)-α、白细胞介素(IL)-6、IL-8的含量。结果两组脱机情况和住院费用无显著性差异(P > 0.05),康复组机械通气时间和住院时间均短于对照组(t > 2.067, P < 0.05)。治疗后,对照组APACHEⅡ评分,TNF-α、IL-6含量均降低(t > 2.040, P < 0.05);康复组APACHEⅡ评分、TNF-α、IL-6、IL-8均显著降低(t > 4.141, P < 0.001);康复组TNF-α、IL-6、IL-8含量均低于对照组(t > 2.217, P < 0.05)。康复组所有指标改善幅度均优于对照组(|Z| > 2.104, P < 0.05)。结论对于重症监护室机械通气患者,早期进行个体化康复治疗可以改善患者的镇静程度,减轻炎症反应,加速脱机进程,减少住院时间,且并未产生额外住院费用。

关键词: 机械通气, 早期个体化康复, 重症监护室

Abstract:

Objective To explore the effect of early individualized rehabilitation on patients with severe mechanical ventilation. Methods A total of 36 patients on mechanical ventilation admitted to the ICU of the Second Affiliated Hospital of Anhui Medical University from March, 2019 to February, 2020 were randomly divided into control group (n = 18) and rehabilitation group (n = 18). All the patients completed a rehabilitation assessment within 24 hours of admission, including clinical assessment, state of consciousness and muscle strength assessment. The control group was treated with intensive care routine treatment, including symptomatic treatment of primary disease, nutritional support, placement of normal limbs, active and passive movement of limbs. The rehabilitation group received early individualized rehabilitation in addition., including active and passive limb movements, transfer training, physical factor therapy, and respiratory muscle training after the specific evaluation. The mechanical ventilation duration and ICU length of stay, the hospitalization cost, Richmond Agitation and Sedation Scale (RASS), acute Physiology and Chronic Health Evaluation Ⅱ (APACHEⅡ), and the content of tumor necrosis factor (TNF)-α, interleukin (IL)-6 and IL-8 were compared. Results There was no significant difference in the weaning rate and hospitalization cost between two groups (P > 0.05). The mechanical ventilation duration and ICU length of stay were less in the rehabilitation group than in the control group (t > 2.067, P < 0.05). After treatment, the score of APACHEⅡ and the content of TNF-α and IL-6 decreased in the control group (t > 2.040, P < 0.05); the score of APACHEⅡ and the content of TNF-α, IL-6 and IL-8 decreased in the rehabilitation group (t > 4.141, P < 0.001); the content of TNF-α, IL-6 and IL-8 was less in the rehabilitation group than in the control group (t > 2.217, P < 0.05). The improvement of all the indexes was better in the rehabilitation group than in the control group (|Z| > 2.104, P < 0.05). Conclusion For patients on mechanical ventilation, early individualized rehabilitation could improve the sedation, relieve the inflammatory reaction, accelerate the process of weaning, and reduce the length of stay with no extra cost.

Key words: mechanical ventilation, early individualized rehabilitation, intensive care unit

中图分类号:

R563.8

毛晶,唐晓晓,郑瑶,张金牛,阚秀丽,吴建贤. 重症机械通气患者早期个体化康复的效果[J]. 《中国康复理论与实践》, 2022, 28(6): 710-715.

MAO Jing,TANG Xiaoxiao,ZHENG Yao,ZHANG Jinniu,KAN Xiuli,WU Jianxian. Effect of early individualized rehabilitation on patients with severe mechanical ventilation[J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2022, 28(6): 710-715.

图/表 3

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组别	n	年龄/岁	性别/n		机械通气时间/d	脱机/n	住院时间/d	住院费用/元
组别	n	年龄/岁	男	女	机械通气时间/d	脱机/n	住院时间/d	住院费用/元
对照组	18	62.44±15.02	8	10	26.61±12.38	13	33.56±14.53	107785.39±32673.05
康复组	18	61.94±17.20	11	7	19.28±7.84	17	23.28±8.80	89691.39±25645.13
t/χ²值		0.093	1.008		2.123	3.200	2.067	2.343
P值		0.927	0.505		0.041	0.074	0.046	0.073

组别	n		RASS评分	APACHEⅡ评分	TNF-α/pg·mL^-1	IL-6/pg·mL^-1	IL-8/pg·mL^-1
对照组	18	治疗前	-1.33±2.57	17.56±1.15	107.91±19.08	136.83±16.16	166.48±23.81
		治疗后	-2.22±1.56	14.61±2.25	87.91±19.47	123.45±22.65	149.74±23.70
康复组	18	治疗前	-1.61±2.36	18.33±1.41	106.20±16.78	135.94±12.84	163.75±17.42
		治疗后	-1.39±1.79	12.89±2.85	70.80±22.03	101.59±28.54	127.38±32.93
t值^a			1.257	4.940	3.111	2.040	1.960
P值^a			0.219	< 0.001	0.004	0.049	0.058
t值^b			-0.319	7.267	5.422	4.656	4.141
P值^b			0.752	< 0.001	< 0.001	< 0.001	< 0.001
t值^c			0.338	-1.811	0.285	0.183	0.392
P值^c			0.737	0.079	0.778	0.856	0.679
t值^d			-1.493	2.013	2.469	2.545	2.217
P值^d			0.145	0.052	0.019	0.016	0.033

组别	n	RASS评分改善值	APACHEⅡ评分		TNF-α		IL-6		IL-8
组别	n	RASS评分改善值	下降值	下降率/%	下降值/pg·mL^-1	下降率/%	下降值/pg·mL^-1	下降率/%	下降值/pg·mL^-1	下降率/%
对照组	18	0.00 (0.00, 0.25)	2.00 (1.00, 4.00)	12.13 (5.80, 23.53)	16.40 (11.35, 25.65)	16.65 (11.79, 20.90)	11.40 (3.80, 22.17)	7.98 (2.61, 16.35)	10.90 (5.80, 28.05)	6.19 (3.46, 16.90)
康复组	18	1.00 (0.00, 2.00)	4.50 (4.00, 8.00)	25.00 (20.79, 44.44)	41.90 (23.42, 50.55)	42.89 (19.58, 47.63)	37.05 (10.87, 49.65)	26.96 (8.37, 38.64)	43.00 (11.65, 53.90)	26.99 (6.36, 33.63)
Z值		-2.466	-2.937	-2.901	-2.626	-2.468	-2.849	-2.816	-2.630	-2.104
P值		0.014	0.003	0.003	0.009	0.014	0.004	0.005	0.013	0.035

重症机械通气患者早期个体化康复的效果

Effect of early individualized rehabilitation on patients with severe mechanical ventilation

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