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早期活动对机械通气患者出院转归的影响。

Effect of early mobilization on discharge disposition of mechanically ventilated patients.

作者信息

Ota Hideki, Kawai Hideki, Sato Makoto, Ito Kazuaki, Fujishima Satoshi, Suzuki Hiroko

机构信息

Department of Thoracic Surgery, Akita Red Cross Hospital, Japan ; Respiratory Support Team, Akita Red Cross Hospital, Japan.

Department of Thoracic Surgery, Akita Red Cross Hospital, Japan.

出版信息

J Phys Ther Sci. 2015 Mar;27(3):859-64. doi: 10.1589/jpts.27.859. Epub 2015 Mar 31.

Abstract

[Purpose] The purpose of this study was to clarify the benefits of early mobilization for mechanically ventilated patients for their survival to discharge to home from the hospital. [Subjects and Methods] Medical records were retrospectively analyzed of patients who satisfied the following criteria: age ≥ 18 years; performance status 0-2 and independent living at their home before admission; mechanical ventilation for more than 48 h; and survival after mechanical ventilation. Mechanically ventilated patients in the early mobilization (EM) group (n = 48) received mobilization therapy, limb exercise and chest physiotherapy, whereas those in the control group (n = 60) received bed rest alone. Univariate and multivariate logistic regression analyses were performed to identify clinical variables associated with discharge disposition. [Results] Early mobilization was a positive independent factor and the presence of neurological deficits was a negative factor contributing to discharge to home. Among patients surviving mechanical ventilation without neurological deficits, the rate of discharge to home was significantly higher among patients in the EM group that in the control group (76% vs. 40%). [Conclusion] Early mobilization can improve the rate of discharge to home of patients requiring mechanical ventilation because of non-neurological deficits.

摘要

[目的] 本研究旨在阐明早期活动对机械通气患者从医院存活出院回家的益处。[对象与方法] 对符合以下标准的患者病历进行回顾性分析:年龄≥18岁;入院前体能状态为0 - 2级且独立生活在家;机械通气超过48小时;机械通气后存活。早期活动(EM)组(n = 48)的机械通气患者接受活动治疗、肢体运动和胸部物理治疗,而对照组(n = 60)的患者仅卧床休息。进行单因素和多因素逻辑回归分析以确定与出院处置相关的临床变量。[结果] 早期活动是一个积极的独立因素,而存在神经功能缺损是影响出院回家的消极因素。在机械通气后存活且无神经功能缺损的患者中,EM组患者出院回家的比例显著高于对照组(76%对40%)。[结论] 早期活动可提高因非神经功能缺损而需要机械通气患者的出院回家率。

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