ICU老年机械通气患者握力现状与影响因素分析

doi:10.3761/j.issn.0254-1769.2022.03.004

摘要/Abstract

摘要：

目的调查ICU老年机械通气患者握力现状,并探讨其影响因素。方法便利选取2020年1月—12月浙江省某三级甲等医院ICU收治的218例老年机械通气患者作为调查对象,采用一般资料调查表、电子握力器、营养风险评估量表2002对其进行横断面调查。采用多元线性回归分析老年机械通气患者握力的影响因素。结果 ICU老年机械通气患者的握力为（13.8±4.7） kg。多元线性回归分析显示,性别、年龄、运动方式、镇静药物使用时间、营养风险评估量表2002评分是影响其握力的主要因素（P<0.05）。结论 ICU老年机械通气患者的握力较低,女性、高龄、既往不运动、镇静药物使用时间>5 d、营养风险评估量表2002评分≥3分的机械通气患者握力较低。护理人员应加强其握力的动态评估,控制相关影响因素。

关键词: 危重病, 机械通气, 握力, 影响因素分析, 护理

Abstract:

Objective To investigate the current status of grip strength level in elderly patients with mechanical ventilation in ICU,and to explore its influencing factors. Methods The convenient sampling method was adopted to select 218 elderly mechanical ventilation patients in ICU of a tertiary hospital in Zhejiang Province as the research subjects from January 2020 to December,and researchers completed the cross-sectional study by using a general information questionnaire,an electronic grip strength device,and the Nutrition Risk Scaling 2002. Multivariate linear regression was used to analyse the factors influencing the grip strength level of elderly patients with mechanical ventilation. Results The average grip strength level of elderly patients with mechanical ventilation in ICU was（13.8±4.7） kg. Multivariate linear regression analysis showed that gender,age,exercise mode,time of sedative drugs,and score of Nutrition Risk Scaling 2002 were the main factors influencing their grip strength level（P<0.05）. Conclusion Grip strength levels were relatively low in elderly patients with mechanical ventilation in ICU. Grip strength levels were lower in patients with mechanical ventilation who were female,elderly,previously unexercised,the time of using sedation medication for >5 d,and the score of Nutrition Risk Scaling 2002≥3. Nursing staff should strengthen the dynamic evaluation of grip strength in patients with mechanical ventilation and control the related influencing factors.

Key words: Critical Illness, Mechanical Ventilation, Grip Strength, Root Cause Analysis, Nursing Care

马鑫, 章亚平, 谢波, 姬晓伟, 王兵, 叶莉莉, 李义, 周庆. ICU老年机械通气患者握力现状与影响因素分析[J]. 中华护理杂志, 2022, 57(3): 279-283.

MA Xin, ZHANG Yaping, XIE Bo, JI Xiaowei, WANG Bing, YE Lili, LI Yi, ZHOU Qing. Status and influencing factors of grip strength in elderly patients with mechanical ventilation in ICU[J]. Chinese Journal of Nursing, 2022, 57(3): 279-283.

图/表 3

表1 ICU老年机械通气患者一般资料及握力的单因素分析结果（n=218）

Table 1 Univariate analysis of general data and grip strength of elderly patients with mechanical ventilation in ICU （n=218）

表2 自变量赋值方式

Table 2 Independent variables assignment

表3 ICU老年机械通气患者握力影响因素的多元线性回归分析

Table 3 Multiple linear regression analysis of influencing factors of grip strength in elderly ICU patients with mechanical ventilation

参考文献 22

[1]	Dres M, Dubé BP, Mayaux J, et al. Coexistence and impact of limb muscle and diaphragm weakness at time of liberation from mechanical ventilation in medical intensive care unit patients[J]. Am J Respir Crit Care Med, 2017,195(1):57-66. DOI URL
[2]	冯会颖, 詹庆元, 黄絮, 等. 重症监护病房患者获得性肌无力的危险因素及诊断方法[J]. 中华危重病急救医学, 2021,33(4):460-465.
	Feng HY, Zhan QY, Huang X, et al. Risk factors and diagnostic methods of intensive care unit-acquired weakness[J]. Chin Crit Care Med, 2021,33(4):460-465.
[3]	潘世琴, 王丽, 王玉宇. 危重症患者肌力评定方法的研究进展[J]. 中国康复理论与实践, 2019,25(9):1052-1056.
	Pan SQ, Wang L, Wang YY. Advance in muscle strength assessment for critical patients(review)[J]. Chin J Rehabi Theory Pract, 2019,25(9):1052-1056.
[4]	Bragan a RD, Ravetti CG, Barreto L, et al. Use of handgrip dynamometry for diagnosis and prognosis assessment of intensive care unit acquired weakness:a prospective study[J]. Heart Lung, 2019,48(6):532-537. DOI URL
[5]	Celis-Morales CA, Welsh P, Lyall DM, et al. Associations of grip strength with cardiovascular,respiratory,and cancer outcomes and all cause mortality:prospective cohort study of half a million UK Biobank participants[J]. BMJ, 2018,361:k1651.
[6]	中华医学会重症医学分会. 机械通气临床应用指南(2006)[J]. 中国危重病急救医学, 2007,19(2):65-72.
	Society of Critical Care Medicine of Chinese Medical Association. Practical guidelines for mechanical ventilation(2006)[J]. Chin Crit Care Med, 2007,19(2):65-72.
[7]	中国痴呆与认知障碍诊治指南写作组, 中国医师协会神经内科医师分会认知障碍疾病专业委员会. 2018中国痴呆与认知障碍诊治指南(五):轻度认知障碍的诊断与治疗[J]. 中华医学杂志, 2018,98(17):1294-1301.
	Writing Group of Guidelines for the Diagnosis and Treatment of Dementia, and Cognitive Impairment in China, Professional Committee of Cognitive Disorders of Neurologist Branch of Chinese Medical Doctor Association. 2018 guidelines for the diagnosis and treatment of dementia and cognitive disorders in China(V):diagnosis and treatment of mild cognitive impairment[J]. Natl Med J China, 2018,98(17):1294-1301.
[8]	苏丽琴, 殷召雪, 王晓晨, 等. 中国长寿地区60岁及以上老年人握力状况调查[J]. 中华预防医学杂志, 2017,51(11):1007-1011. PMID
	Su LQ, Yin ZX, Wang XC, et al. Study on handgrip strength of elderly ≥60 years old from longevity areas in China[J]. Chin J Prev Med, 2017,51(11):1007-1011. DOI PMID
[9]	Pan PJ, Lin CH, Yang NP, et al. Normative data and associated factors of hand grip strength among elderly individuals:the Yilan Study,Taiwan[J]. Sci Rep, 2020,10(1):6611. DOI URL
[10]	Chlan LL, Tracy MF, Guttormson J, et al. Peripheral muscle strength and correlates of muscle weakness in patients receiving mechanical ventilation[J]. Am J Crit Care, 2015,24(6):e91-e98. DOI URL
[11]	林英, 张静, 时珍, 等. 福州市养老机构老年人握力水平及影响因素[J]. 中国老年学杂志, 2019,39(5):1226-1230.
	Lin Y, Zhang J, Shi Z, et al. Grip strength level and influencing factors of the elderly in Fuzhou pension institutions[J]. Chin J Gerontol, 2019,39(5):1226-1230.
[12]	吴振云, 钮美娥, 韩燕霞, 等. 握力测试在评估稳定期慢性阻塞性肺疾病患者活动能力中的应用研究[J]. 中华护理杂志, 2017,52(8):926-929.
	Wu ZY, Niu ME, Han YX, et al. Application of handgrip strength test for evaluating mobility in patients with stable chronic obstructive pulmonary disease(COPD)[J]. Chin J Nurs, 2017,52(8):926-929.
[13]	韩汝宁, 李秀川, 赵士兵, 等. ICU患者早期康复方案的构建及应用研究[J]. 中华护理杂志, 2020,55(1):8-15.
	Han RN, Li XC, Zhao SB, et al. Construction and application of early rehabilitation scheme for intensive care unit patients[J]. Chin J Nurs, 2020,55(1):8-15.
[14]	Collado-Boira E, Baliño P, Boldo-Roda A, et al. Influence of female sex hormones on ultra-running performance and post-race recovery:role of testosterone[J]. Int J Environ Res Public Health, 2021,18(19):10403. DOI URL
[15]	Priego T, Martín AI, González-Hedström D, et al. Role of hormones in sarcopenia[J]. Vitam Horm, 2021,115:535-570. DOI PMID
[16]	张腾飞, 刘欢, 舒永梅, 等. 有氧运动结合力量训练对中老年女性握力及功能性体适能的影响[J]. 中国康复医学杂志, 2015,30(12):1243-1247.
	Zhang TF, Liu H, Shu YM, et al. Effects of aerobic exercise and strength training on the hand grip strength and functional fitness in the middle aged and elder women[J]. Chin J Rehabil Med, 2015,30(12):1243-1247.
[17]	陈颖. 力量训练对45-60岁女性肌流失及肌力的影响[D]. 西安:西安体育学院, 2019.
	Chen Y. Effect of strength training on muscle loss and muscle strength in females aged 45-60 years[D]. Xi’an:Xi’an Physical Education University, 2019.
[18]	Chung PK, Zhang CQ, Zhao YN, et al. Effectiveness of resistance training on resilience in Hong Kong Chinese older adults:study protocol for a randomized controlled trial[J]. BMC Geriatr, 2021,21(1):250. DOI URL
[19]	董欣, 莫懿晗, 王秀华, 等. 抗阻运动对老年肌少症危险人群肌肉量、肌力和活动能力的影响[J]. 中国护理管理, 2021,21(8):1190-1195.
	Dong X, Mo YH, Wang XH, et al. Effects of resistance exercise on muscle mass,muscle strength and physical performance in the elderly at risk of sarcopenia[J]. Chin Nurs Manag, 2021,21(8):1190-1195.
[20]	Lim R, Kalisch Ellett LM, Widagdo IS, et al. Analysis of anticholinergic and sedative medicine effects on physical function,cognitive function,appetite and frailty:a cross-sectional study in Australia[J]. BMJ Open, 2019,9(9):e029221. DOI URL
[21]	卢婷, 应燕萍, 徐谊, 等. 握力与NRS 2002在恶性肿瘤患者营养风险筛查中的对比研究[J]. 护理学报, 2021,28(9):1-4.
	Lu T, Ying YP, Xu Y, et al. A comparative study of handgrip strength and NRS 2002 in nutritional risk screening of patients with malignant tumors[J]. J Nurs China, 2021,28(9):1-4.
[22]	许秀娟, 张庚, 胡马洪, 等. 临床营养支持方式对机械通气效果的影响[J]. 中华危重病急救医学, 2018,30(3):262-265.
	Xu XJ, Zhang G, Hu MH, et al. Influence of clinical nutritional support on the effects of mechanical ventilation[J]. Chin Crit Care Med, 2018,30(3):262-265.