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

Abstract

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

CLC Number:

R563.8

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.

Figures/Tables 3

References 34

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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

Effect of early individualized rehabilitation on patients with severe mechanical ventilation

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