序贯性早期床上运动对ICU老年患者肌力及自理能力的影响
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摘要
目的探讨序贯性早期床上运动对ICU老年患者肌力及自理能力的影响。方法将80例ICU老年患者按随机数字表法分为干预组42例和对照组38例。对照组予ICU常规护理及运动,干预组在对照组基础上实施序贯性早期床上运动。比较两组干预前及转出ICU时MRC肌力评分、Barthel指数评分及机械通气时间、ICU住院时间及总住院时间。结果干预组转出ICU时MRC肌力评分及Barthel指数评分显著高于对照组,机械通气时间及ICU住院时间显著短于对照组(P<0.05,P<0.01)。结论序贯性早期床上运动有利于提高老年患者肌力,改善其自理能力,缩短机械通气时间及ICU治疗时间。
Objective To identify the effect of early progressive in-bed mobilization on muscle strength and self-care ability of elderly intensive care patients. Methods Eighty elderly patients in ICU were randomized into an intervention group(n=42) and a control group(n=38), receiving either routine mobilization program or an early progressive in-bed mobility program. Muscle strength was evaluated using the Medical Research Council(MRC) scale and self-care ability was measured using the Barthel Index(BI) before the intervention and during patient transfer from the ICU to ward. The length of mechanical ventilation, ICU stay and hospital stay were also compared between the two groups. Results The intervention group had higher MRC score and BI score compared with the control group during patient transfer from the ICU(P<0.05, P<0.01). The length of mechanical ventilation and ICU stay were significantly shorter in the intervention than those in the control group(P<0.05, P<0.01). Conclusion The early progressive in-bed mobilization program contributes to improving muscle strength and self-care ability of patients, and shorten mechanical ventilation and ICU stay.
Objective To identify the effect of early progressive in-bed mobilization on muscle strength and self-care ability of elderly intensive care patients. Methods Eighty elderly patients in ICU were randomized into an intervention group(n=42) and a control group(n=38), receiving either routine mobilization program or an early progressive in-bed mobility program. Muscle strength was evaluated using the Medical Research Council(MRC) scale and self-care ability was measured using the Barthel Index(BI) before the intervention and during patient transfer from the ICU to ward. The length of mechanical ventilation, ICU stay and hospital stay were also compared between the two groups. Results The intervention group had higher MRC score and BI score compared with the control group during patient transfer from the ICU(P<0.05, P<0.01). The length of mechanical ventilation and ICU stay were significantly shorter in the intervention than those in the control group(P<0.05, P<0.01). Conclusion The early progressive in-bed mobilization program contributes to improving muscle strength and self-care ability of patients, and shorten mechanical ventilation and ICU stay.
引文
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[14] 姚思华,徐顺霖,高炜.运动康复指导改善高龄老年人衰弱状态的探讨[J].中华老年医学杂志,2017,36(4):468-470.
[15] 苏媛媛,张伟宏,宋晓月,等.弹力带抗阻运动对老年人健康促进生活方式的研究进展[J].中国康复医学杂志,2018,33(1):105-108.
[16] 权明桃,吴华炼,王勇,等.早期运动疗法对老年机械通气患者谵妄的干预效果[J].中华老年医学杂志,2016,35(10):1099-1102.
[17] Hashem M D,Parker A M,Needham D M.Early mobilization and rehabilitation of patients who are critically ill[J].Chest,2016,150(3):722-731.
[18] 朱云龙,袁光雄,许俊,等.早期康复训练对严重脓毒症患者ICU获得性肌无力的影响[J].内科急危重症杂志,2016,22(1):43-45.
[19] Fan E,Cheek F,Chlan L,et al.An Official American Thoracic Society Clinical Practice Guideline:the diagnosis of intensive care unit-acquired weakness in adults[J].Am J Respir Crit Care Med,2014,190(12):1437-1446.
[2] Zorowitz R D.ICU-acquired weakness:a rehabilitation perspective of diagnosis,treatment,and functional ma-nagement[J].Chest,2016,150(4):966-971.
[3] 任海静,胡景萍,任海妹.老年人肌力减退及预防的研究进展[J].中国老年学杂志,2013,33(21):5484-5487.
[4] De Jonghe B,Sharshar T,Lefaucheur J P,et al.Paresis acquired in the intensive care unit:a prospective multicenter study[J].JAMA,2002,288(22):2859-2867.
[5] Topp R,Ditmyer M,King K,et al.The effect of bed rest and potential of prehabilitation on patients in the intensive care unit[J].AACN Clin Issues,2002,13(2):263-276.
[6] Hermans G,De Jonghe B,Bruyninckx F,et al.Clinical review:critical illness polyneuropathy and myopathy[J].Crit Care,2008,12(6):238.
[7] Castro E,Turcinovic M,Platz J,et al.Early mobilization:changing the mindset[J].Crit Care Nurse,2015,35(4):e1-e6.
[8] 岳萌,姚培宇,崔楚云,等.机械通气患者早期活动效果的系统评价[J].中华护理杂志,2016,51(5):551-557.
[9] 杨富,方芳,陈兰,等.ICU早期康复的研究进展[J].护理学杂志,2017,32(10):100-103.
[10] 赵贵美,焦琳琳,杨桂华.早期循序渐进运动对ICU患者获得性衰弱影响的Meta分析[J].中华护理杂志,2017,52(2):177-181.
[11] 杨丽平,张志刚,张彩云,等.机械通气患者早期主动活动效果的Meta分析[J].中国护理管理,2017,17(6):758-764.
[12] 郭军辉.早期康复治疗在综合ICU中的应用价值研究[D].天津:天津医科大学,2016.
[13] 黄海燕,王小芳,罗健,等.ICU机械通气患者早期四级康复训练效果[J].护理学杂志,2016,31(15):1-5.
[14] 姚思华,徐顺霖,高炜.运动康复指导改善高龄老年人衰弱状态的探讨[J].中华老年医学杂志,2017,36(4):468-470.
[15] 苏媛媛,张伟宏,宋晓月,等.弹力带抗阻运动对老年人健康促进生活方式的研究进展[J].中国康复医学杂志,2018,33(1):105-108.
[16] 权明桃,吴华炼,王勇,等.早期运动疗法对老年机械通气患者谵妄的干预效果[J].中华老年医学杂志,2016,35(10):1099-1102.
[17] Hashem M D,Parker A M,Needham D M.Early mobilization and rehabilitation of patients who are critically ill[J].Chest,2016,150(3):722-731.
[18] 朱云龙,袁光雄,许俊,等.早期康复训练对严重脓毒症患者ICU获得性肌无力的影响[J].内科急危重症杂志,2016,22(1):43-45.
[19] Fan E,Cheek F,Chlan L,et al.An Official American Thoracic Society Clinical Practice Guideline:the diagnosis of intensive care unit-acquired weakness in adults[J].Am J Respir Crit Care Med,2014,190(12):1437-1446.