Martin Ubaldo J, Hincapie Luis, Nimchuk Mark, Gaughan John, Criner Gerard J
Division of Pulmonary and Critical Care Medicine, Temple University School of Medicine, Philadelphia, PA, USA.
Crit Care Med. 2005 Oct;33(10):2259-65. doi: 10.1097/01.ccm.0000181730.02238.9b.
To evaluate the prevalence and magnitude of weakness in patients receiving chronic mechanical ventilation and the impact of providing aggressive whole-body rehabilitation on conventional weaning variables, muscle strength, and overall functional status.
Retrospective analysis of 49 consecutive patients.
Multidisciplinary ventilatory rehabilitation unit in an academic medical center.
Forty-nine consecutive chronic ventilator-dependent patients referred to a tertiary care hospital ventilator rehabilitation unit.
None.
Patients were 58 +/- 7 yrs old with multiple etiologies for respiratory failure. On admission, all patients were bedridden and had severe weakness of upper and lower extremities measured by a 5-point muscle strength score and a 7-point Functional Independence Measurement. Postrehabilitation, patients had increases in upper and lower extremity strength (p < .05) and were able to stand and ambulate. All weaned from mechanical ventilation, but three required subsequent intermittent support. Six patients died before hospital discharge. Upper extremity strength on admission inversely correlated with time to wean from mechanical ventilation (R = .72, p < .001).
: Patients receiving chronic ventilation are weak and deconditioned but respond to aggressive whole-body and respiratory muscle training with an improvement in strength, weaning outcome, and functional status. Whole-body rehabilitation should be considered a significant component of their therapy.
评估接受长期机械通气患者的虚弱发生率及严重程度，以及积极进行全身康复对传统撤机变量、肌肉力量和整体功能状态的影响。
对49例连续患者进行回顾性分析。
一所学术医疗中心的多学科通气康复单元。
49例连续的依赖呼吸机的慢性患者，被转诊至一家三级医院的呼吸机康复单元。
无。
患者年龄为58±7岁，呼吸衰竭病因多样。入院时，所有患者均卧床，通过5分制肌肉力量评分和7分制功能独立性测量法评估，其上下肢均有严重虚弱。康复后，患者上下肢力量增强（p<0.05），能够站立和行走。所有患者均成功撤机，但3例患者随后需要间歇性支持。6例患者在出院前死亡。入院时上肢力量与机械通气撤机时间呈负相关（R = 0.72，p<0.001）。
接受长期通气的患者虚弱且身体状况不佳，但积极进行全身及呼吸肌训练后，力量、撤机结果和功能状态均有所改善。全身康复应被视为其治疗的重要组成部分。
