早期康复治疗对机械通气患者的影响。
Effects of early rehabilitation therapy on patients with mechanical ventilation.
机构信息
Intensive Care Unit, Affiliated Hospital of Medical College, Qingdao University, Qingdao 266003, China.
出版信息
World J Emerg Med. 2014;5(1):48-52. doi: 10.5847/wjem.j.issn.1920-8642.2014.01.008.
BACKGROUND
For patients in intensive care unit (ICU), mechanical ventilation is an effective treatment to survive from acute illness and improve survival rates. However, long periods of bed rest and restricted physical activity can result in side effects. This study aimed to investigate the feasibility of early rehabilitation therapy in patients with mechanical ventilation.
METHODS
A randomized controlled trial was carried out. Sixty patients, with tracheal intubation or tracheostomy more than 48 hours and less than 72 hours, were admitted to the ICU of the Affiliated Hospital of Medical College, Qingdao University, from May 2010 to May 2012. These patients were randomly divided into a rehabilitation group and a control group. In the rehabilitation group, rehabilitation therapy was performed twice daily, and the training time and intensity were adjusted according to the condition of the patients. Early rehabilitation therapy included heading up actively, transferring from the supine position to sitting position, sitting at the edge of the bed, sitting in chair, transferring from sitting to standing, and ambulating bedside. The patient's body mass index, days to first out of bed, duration of mechanical ventilation, length of ICU stay, APACHE II score, highest FiO2, lowest PaO2/FiO2 and hospital mortality of patients were all compared between the rehabilitation group and the control group. The differences between the two groups were compared using Student's t test.
RESULTS
There was no significant difference in body mass index, APACHE II score, highest FiO2, lowest PaO2/FiO2 and hospital mortality between the rehabilitation group and the control group (P>0.05). Patients in the rehabilitation group had shorter days to first out of bed (3.8±1.2 d vs. 7.3±2.8 d; P=0.00), duration of mechanical ventilation (5.6±2.1 d vs. 12.7±4.1 d; P=0.005) and length of ICU stay (12.7±4.1 d vs. 15.2±4.5 d; P=0.01) compared with the control group.
CONCLUSION
Early rehabilitation therapy was feasible and effective in improving the outcomes of patients with mechanical ventilation.
背景
对于重症监护病房（ICU）的患者来说，机械通气是一种从急性疾病中存活并提高生存率的有效治疗方法。然而，长时间的卧床休息和限制身体活动会导致副作用。本研究旨在探讨机械通气患者早期康复治疗的可行性。
方法
进行了一项随机对照试验。2010 年 5 月至 2012 年 5 月，青岛大学医学院附属医院 ICU 收治了 60 例气管插管或气管切开>48 小时且<72 小时的患者。这些患者被随机分为康复组和对照组。在康复组中，每天进行两次康复治疗，根据患者的情况调整训练时间和强度。早期康复治疗包括主动抬头、从仰卧位转为坐位、坐在床边、坐在椅子上、从坐位转为站立位、床边行走。比较康复组和对照组患者的体质量指数、首次下床时间、机械通气时间、住 ICU 时间、急性生理与慢性健康评分（APACHE II）、最高吸氧浓度（FiO2）、最低氧合指数（PaO2/FiO2）和住院病死率。采用 Student's t 检验比较两组间差异。
结果
康复组与对照组患者的体质量指数、APACHE II 评分、最高 FiO2、最低 PaO2/FiO2 和住院病死率差异无统计学意义（P>0.05）。康复组患者首次下床时间（3.8±1.2 d 比 7.3±2.8 d；P=0.00）、机械通气时间（5.6±2.1 d 比 12.7±4.1 d；P=0.005）和住 ICU 时间（12.7±4.1 d 比 15.2±4.5 d；P=0.01）均短于对照组。
结论
早期康复治疗在改善机械通气患者预后方面是可行且有效的。
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