危重症幸存者的门诊物理康复：一项随机对照试验。
Outpatient-based physical rehabilitation for survivors of prolonged critical illness: A randomized controlled trial.
作者信息
McWilliams David J, Benington Steve, Atkinson Dougal
机构信息
a Therapy Services, University Hospitals Birmingham NHS Foundation Trust, New Queen Elizabeth Hospital, Edgbaston , Birmingham , UK.
b Department of Critical Care , Manchester Royal Infirmary, Central Manchester and Manchester Children's NHS Foundation Trust , Manchester , UK.
出版信息
Physiother Theory Pract. 2016;32(3):179-90. doi: 10.3109/09593985.2015.1137663. Epub 2016 Apr 4.
INTRODUCTION
The physical and psychological impact of critical illness is well documented. Recovery may take many months and is often incomplete. The optimal way of addressing these important sequelae following hospital discharge remains unclear.
METHODS
Single center, randomized controlled trial in patients invasively ventilated for ≥5 days. The treatment group (TG) underwent a 7-week, outpatient-based exercise and education program, with the control group (CG) receiving no intervention during the study period. Primary outcome measures were changes in functional capacity assessed using the cardiopulmonary exercise testing parameters, peak VO2, and anaerobic threshold (AT). Secondary outcome measures were changes in and health-related quality of life assessed using the Short Form 36 version 2 questionnaire. Assessors remained blinded to group allocation.
RESULTS
Sixty-three patients completed the study (target n = 90). Improvements in both peak VO2 and AT were seen in both TG and CG but no significant difference between groups was evident. AT improved by 11.7% in CG (baseline 10.3 ml O2 kg(-1) min(-1), follow-up 11.5 ml O2 kg(-1) min(-1)), and by 14.6% in TG (baseline 10.3 ml O2 kg(-1) min(-1), follow-up 11.8 ml O2 kg(-1) min(-1); ANCOVA p = 0.74). Peak VO2 improved by 14.0% in CG (baseline 13.6 ml O2 kg(-1) min(-1), follow-up 15.5 ml O2 kg(-1) min(-1)), and by 18.8% in TG (baseline 13.8 ml O2 kg(-1) min(-1), follow-up 16.4 ml O2 kg(-1) min(-1); ANCOVA p = 0.68). Significant improvements were seen in both groups for physical component summary scores (PCS) (TG 39.6 versus 31.0; CG 36.1 versus 32.6) and mental component summary scores (MCS) (TG 48.6 versus 38.4; CG 41.3 versus 37.0). The degree of improvement was significantly higher in the treatment group in comparison to control subjects (PCS p = 0.048; MCS p = 0.017). This improvement was most marked in the subgroup ventilated for >14 days.
CONCLUSIONS
A 7-week, outpatient-based exercise and education program resulted in improved health-related quality of life scores but not improved exercise capacity.
引言
危重病对身体和心理的影响已有充分记录。康复可能需要数月时间，而且往往并不完全。出院后应对这些重要后遗症的最佳方法仍不明确。
方法
对进行有创通气≥5天的患者开展单中心随机对照试验。治疗组（TG）接受为期7周的门诊运动和教育项目，对照组（CG）在研究期间不接受任何干预。主要结局指标是使用心肺运动测试参数、峰值摄氧量（VO2）和无氧阈值（AT）评估的功能能力变化。次要结局指标是使用简明健康状况调查简表第2版问卷评估的健康相关生活质量变化。评估人员对分组情况保持盲态。
结果
63名患者完成了研究（目标人数n = 90）。TG和CG的峰值VO2和AT均有改善，但两组之间无明显差异。CG的AT改善了11.7%（基线10.3 ml O2 kg⁻¹ min⁻¹，随访11.5 ml O2 kg⁻¹ min⁻¹），TG改善了14.6%（基线10.3 ml O2 kg⁻¹ min⁻¹，随访11.8 ml O2 kg⁻¹ min⁻¹；协方差分析p = 0.74）。CG的峰值VO2改善了14.0%（基线13.6 ml O2 kg⁻¹ min⁻¹，随访15.5 ml O2 kg⁻¹ min⁻¹），TG改善了18.8%（基线13.8 ml O2 kg⁻¹ min⁻¹，随访16.4 ml O2 kg⁻¹ min⁻¹；协方差分析p = 0.68）。两组的身体成分汇总得分（PCS）（TG 39.6对31.0；CG 36.1对32.6）和心理成分汇总得分（MCS）（TG 48.6对38.4；CG 41.3对37.0）均有显著改善。与对照组相比，治疗组的改善程度显著更高（PCS p = 0.048；MCS p = 0.017）。这种改善在通气超过14天的亚组中最为明显。
结论
为期7周的门诊运动和教育项目可提高健康相关生活质量评分，但不能提高运动能力。
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