摘要
目的观察规范化分级早期康复方案在重症监护病房(ICU)机械通气患者中的应用效果,为患者康复方案的制定提供参考。方法选择2021年7月至2022年6月温州医科大学附属第一医院ICU收治的30例机械通气患者作为对照组(接受常规康复方案);选择同期本院ICU收治的87例机械通气患者作为试验组(按上机后24~48、>48~72、>72~96 h 3个时间点,每个时间点29例,实施规范化分级康复方案)。观察两组机械通气时间、ICU住院时间、总住院时间,以及转入ICU 24 h、转出ICU时急性生理学与慢性健康状况评分Ⅱ(APACHEⅡ)、ICU获得性肌无力(ICU-AW)、呼吸机相关性肺炎(VAP)和谵妄发生率、撤机成功率、不良事件发生率的变化。结果试验组随时间延长,机械通气时间、ICU住院时间、总住院时间均逐渐延长,ICU-AW、VAP、谵妄发生率和不良事件发生率均逐渐升高,撤机成功率逐渐降低;转入ICU 24 h APACHEⅡ评分无明显变化,转出ICU时逐渐升高;但试验组上机后24~48、>48~72、>72~96 h各时间点机械通气时间、ICU住院时间、总住院时间均较对照组明显缩短〔机械通气时间(d):6.45±1.78、7.64±2.03、9.17±2.09比12.66±2.14,ICU住院时间(d):10.78±3.48、12.56±4.33、15.23±3.29比19.53±5.22,总住院时间(d):20.58±5.36、26.44±6.23、28.50±5.79比37.45±9.08,均P<0.05〕,ICU-AW、VAP、谵妄发生率和不良事件发生率以及APACHEⅡ评分均较对照组明显降低〔ICU-AW发生率:3.45%(1/29)、13.79%(4/29)、20.69%(6/29)比33.33%(10/29),VAP发生率:0%(0/29)、10.34%(3/29)、13.79%(4/29)比26.67%(8/29),谵妄发生率:0%(0/29)、13.79%(4/29)、13.79%(4/29)比46.67%(14/30),不良事件发生率:3.45%(1/29)、13.79%(4/29)、24.14%(7/29)比36.67%(11/29),APACHEⅡ评分(分):6.28±2.62、8.78±2.95、10.67±3.08比14.56±3.53,均P<0.05〕,撤机成功率较对照组明显升高〔100.00%(29/29)、93.10%(27/29)、86.21%(25/29)比76.67%(23/30),均P<0.05〕。结论规范化分级早期康复方案能有效缩短ICU患者机械通气、住院时间,降低患者ICU-AW、VAP、谵妄风险,促进患者快速康复,临床应用疗效确切。
Objective To observe the effect of standardized graded early rehabilitation program in patients with mechanical ventilation in intensive care unit(ICU),and to provide reference for the formulation of rehabilitation program.Methods From July 2021 to June 2022,30 cases of patients with mechanical ventilation admitted to ICU of the First Affiliated Hospital of Wenzhou Medical University were selected as control group to receive routine rehabilitation;87 cases of patients with mechanical ventilation in ICU were selected as the experimental group during the same period,and then the experimental group was divided into three time points at 24-48,>48-72,>72-96 hours after ventilation,29 cases at each time point,and standardized graded rehabilitation program was implemented.The duration of mechanical ventilation,length of stay in ICU,and total length of stay in the two groups were observed,as well as the changes of acute physiology and chronic health evaluationⅡ(APACHEⅡ)at 24 hours after admission to ICU and 24 hours transfer out of ICU,the incidence of ICU-acquired myasthenia(ICU-AW),ventilator-associated pneumonia(VAP),delirium,success rate of withdrawal,and incidence of adverse events.Results With the extension of time,the mechanical ventilation time,length of ICU stay,and total length of hospital stay in the experimental group were significantly extended,the incidence of ICU-AW,VAP,delirium,and adverse events were significantly increased,and the success rate of withdrawal was significantly decreased.APACHEⅡscore did not change significantly at 24 hours after transfer to ICU,but increased gradually after transfer out of ICU.The mechanical ventilation time,ICU stay time and total stay time of the experimental group were significantly shortened at 24-48,>48-72,>72-96 hours after mechanical ventilation compared with the control group[mechanical ventilation time(days):6.45±1.78,7.64±2.03,9.17±2.09 vs.12.66±2.14,length of stay in ICU(days):10.78±3.48,12.56±4.33,15.23±3.29 vs.19.53±5.22,total length of stay(days):20.58±5.36,26.44±6.23,28.50±5.79 vs.37.45±9.08,all P<0.05],the incidence of ICU-AW,VAP,delirium,adverse events and APACHEⅡscore in experimental group were significantly decreased compared with control group[incidence of ICU-AW:3.45%(1/29),13.79%(4/29),20.69%(6/29)vs.33.33%(10/29),incidence of VAP:0%(0/29),10.34%(3/29),13.79%(4/29)比26.67%(8/29),incidence of delirium:0%(0/29),13.79%(4/29),13.79%(4/29)vs.46.67%(14/30),incidence of adverse events:3.45%(1/29),13.79%(4/29),24.14%(7/29)vs.36.67%(11/29),APACHEⅡscore:6.28±2.62,8.78±2.95,10.67±3.08 vs.14.56±3.53,all P<0.05].The success rate of experimental group was significantly higher than that of control group[100.00%(29/29),93.10%(27/29),86.21%(25/29)vs.76.67%(23/30),all P<0.05].Conclusion The standardized and graded early rehabilitation program can effectively shorten the mechanical ventilation and hospitalization time of ICU patients,reduce the risk of ICU-AW,VAP,and delirium,and promote the rapid recovery of patients,and the clinical application shows effectiveness.
作者
杨小彩
方少样
全清霞
张其霞
Yang Xiaocai;Fang Shaoxiang;Quan Qingxia;Zhang Qixia(Intensive Care Unit,the First Affiliated Hospital of Wenzhou Medical University,Wenzhou 325015,Zhejiang,China)
出处
《中国中西医结合急救杂志》
CAS
CSCD
北大核心
2022年第6期719-723,共5页
Chinese Journal of Integrated Traditional and Western Medicine in Intensive and Critical Care
基金
浙江省温州市基础性科研项目(Y20210886)
关键词
规范化分级早期康复方案
重症监护病房
机械通气
重症监护病房获得性衰弱
不良事件
Standardized and graded early rehabilitation program
Intensive care unit
Mechanical ventilation
Intensive care unit-acquired frailty
Adverse events
作者简介
通信作者:张其霞,Email:17176453@qq.com
