Cheng Jie, Kong Jiajia, Wang Rui, Ji Kexin, Gao Huiya, Yao Li, Ding Nannan, Zhang Zhigang
School of Nursing, Lanzhou University, Lanzhou 730000, Gansu, China.
Department of Intensive Care Unit, the First Hospital of Lanzhou University, Lanzhou 730000, Gansu, China. Corresponding author: Zhang Zhigang, Email:
Zhonghua Wei Zhong Bing Ji Jiu Yi Xue. 2021 Oct;33(10):1243-1248. doi: 10.3760/cma.j.cn121430-20210628-00962.
To evaluate the effect of lower limb neuromuscular electrical stimulation (NMES) on mechanical ventilation patients in intensive care unit (ICU).
Databases including the Cochrane Library, PubMed, Web of Science, Embase, SinoMed, CNKI, VIP and Wanfang database were searched from inception to May 2021. Randomized controlled trails (RCT) about the influence of NMES of lower limbs in patients with mechanical ventilation in ICU were collected. Routine rehabilitation measures were implemented in the control group, while the combination of routine rehabilitation and NMES on the lower limbs was implemented in the observation group. The literature screening, data extracting, and bias risk assessment of included studies were conducted independently by two reviewers. RevMan 5.3 software was used to perform Meta-analysis. Funnel plot was used to test publication bias.
A total of 8 RCT were eventually enrolled. The literature quality evaluation results showed that 1 study was grade A and 7 studies were grade B, suggesting that the quality of the included literature was relatively high. The Meta-analysis results showed that NMES in the lower extremities could effectively shorten the duration of mechanical ventilation in ICU patients [standardized mean difference (SMD) = -0.51, 95% confidence interval (95%CI) was -0.72 to -0.31, P < 0.000 01], increase the maximum inspiratory pressure [MIP; mean difference (MD) = 14.19, 95%CI was 9.30 to 19.09, P < 0.000 01], and improve the functional status of critically ill patients [functional status score for ICU (FSS-ICU); MD = 10.44, 95%CI was 3.12 to 17.77, P = 0.005] with statistically significances. However, there were no significant advantages in increasing the Medical Research Council (MRC) score (MD = 2.13, 95%CI was -1.38 to 5.63, P = 0.23), reducing ICU mortality [relative risk (RR) = 0.80, 95%CI was 0.51 to 1.24, P = 0.31], shortening length of ICU stay (MD = -0.54, 95%CI was -3.67 to 2.59, P = 0.74), and the combined effect was not statistically significant. Funnel plot based on the duration of mechanical ventilation showed that the distribution of included articles was basically symmetrical, and no publication bias was detected.
NMES of the lower limbs can not only shorten the ventilation duration effectively, but also improve the MIP and functional status of mechanically ventilated patients in ICU. However, it has no significant effect on the MRC score, ICU mortality and length of ICU stay of patients with mechanical ventilation. In the future, high-quality, large sample size and multi-center RCT are needed to verify the effects of NMES.
评估下肢神经肌肉电刺激（NMES）对重症监护病房（ICU）机械通气患者的影响。
检索Cochrane图书馆、PubMed、Web of Science、Embase、中国生物医学文献数据库、中国知网、维普数据库和万方数据库，检索时间从建库至2021年5月。收集关于ICU机械通气患者下肢NMES影响的随机对照试验（RCT）。对照组实施常规康复措施，观察组实施常规康复与下肢NMES相结合的措施。由两名研究者独立进行纳入研究的文献筛选、数据提取和偏倚风险评估。使用RevMan 5.3软件进行Meta分析。采用漏斗图检验发表偏倚。
最终纳入8项RCT。文献质量评价结果显示，1项研究为A级，7项研究为B级，表明纳入文献质量较高。Meta分析结果显示，下肢NMES可有效缩短ICU患者机械通气时间[标准化均数差（SMD）=-0.51，95%置信区间（95%CI）为-0.72至-0.31，P<0.000 01]，提高最大吸气压力[MIP；均数差（MD）=14.19，95%CI为9.30至19.09，P<0.000 01]，并改善危重症患者的功能状态[ICU功能状态评分（FSS-ICU）；MD=10.44，95%CI为3.12至17.77，P=0.005]，差异均有统计学意义。然而，在提高医学研究委员会（MRC）评分（MD=2.13，95%CI为-1.38至5.63，P=0.23）、降低ICU死亡率[相对危险度（RR）=0.80，95%CI为0.51至1.24，P=0.31]、缩短ICU住院时间（MD=-0.54，95%CI为-3.67至2.59，P=0.74）方面无显著优势，联合效应无统计学意义。基于机械通气时间的漏斗图显示，纳入文章分布基本对称，未检测到发表偏倚。
下肢NMES不仅可有效缩短机械通气时间，还可改善ICU机械通气患者的MIP和功能状态。然而，对机械通气患者的MRC评分、ICU死亡率及ICU住院时间无显著影响。未来需要高质量、大样本量和多中心的RCT来验证NMES的效果。
