ICU机械通气患者膈肌锻炼方案的构建及应用研究

doi:10.3761/j.issn.0254-1769.2023.03.001

摘要/Abstract

摘要：

目的构建ICU机械通气患者膈肌锻炼方案，并探讨其临床应用的效果。方法在文献分析和专家会议的基础上构建ICU机械通气患者膈肌锻炼方案。2020年10月—2021年10月，选取遵义市某三级甲等医院综合ICU的成人机械通气患者69例，随机分为试验组（35例）和对照组（34例）。试验组在常规康复护理及早期活动的基础上接受膈肌锻炼，对照组接受常规康复护理及早期活动。采用超声评估两组干预前和干预后24、48、72、120 h吸气末膈肌厚度、呼气末膈肌厚度、膈肌增厚分数、膈肌移动度；比较两组撤机成功率和不良事件发生率。结果试验组33例、对照组31例完成研究。重复测量方差分析显示，两组吸气末膈肌厚度的时间效应、交互效应具有统计学意义（P<0.05）；两组呼气末膈肌厚度的时间效应具有统计学意义（P<0.005）；两组膈肌增厚分数的时间效应、交互效应具有统计学意义（P<0.05）；两组膈肌移动度的时间效应、交互效应具有统计学意义（P<0.05）。干预后120 h，试验组吸气末膈肌厚度高于对照组，干预后72、120 h，试验组膈肌增厚分数高于对照组，干预后120 h试验组膈肌移动度高于对照组，差异具有统计学意义（P<0.05）。试验组撤机成功率高于对照组，差异具有统计学意义（P<0.05）。两组均未发生血氧饱和度骤降、心动过速、肌肉骨骼损伤等不良事件。结论 ICU机械通气患者膈肌锻炼方案是安全可行的，可改善患者膈肌功能，提高撤机成功率，促进患者康复。

关键词: 重症监护病房, 机械通气, 膈肌锻炼, 康复护理

Abstract:

Objective To construct a diaphragm exercise program for patients with mechanical ventilation in intensive care unit（ICU），and to explore its clinical application effect. Methods Based on literature analysis and expert meeting，a diaphragm exercise program of ICU patients with mechanical ventilation was constructed. A total of 69 adult patients with mechanical ventilation in our comprehensive ICU from October 2020 to October 2021 were randomly divided into an experimental group（35 cases） and a control group（34 cases）. The control group was given ICU routine rehabilitation nursing care and early activities，and the experimental group was given the diaphragm exercise on the basis of the interventions in the control group. End-inspiratory diaphragm thickness （DTei），end-expiratory diaphragm thickness（DTee），diaphragm thickening fraction（DTF） and diaphragmatic excursion（DE） were evaluated by ultrasound before and 24，48，72 and 120 hours after intervention. The success rate of weaning and the incidence of adverse events were compared and analyzed between the 2 groups. Results Repeated measures ANOVA showed that the time effect and interaction effect of DTei between the 2 groups were statistically significant（P<0.05）；the time effect of DTee in the 2 groups was statistically significant（P<0.05）；the time effect and interaction effect of DTF in the 2 groups were statistically significant（P<0.05）；the time effect and interaction effect of DE in the 2 groups were statistically significant（P<0.05）. The DTei of the experimental group was higher than that of the control group at 120 h after intervention；the DTF of the experimental group was higher than that of the control group at 72 h and 120 h after intervention；the DE of the experimental group was higher than that of the control group at 120 h after intervention；the differences were statistically significant（P<0.05）. The weaning success rate of the experimental group was higher than that of the control group，and the difference was statistically significant（P<0.05）. There were no adverse events such as sudden drop of oxygen saturation，tachycardia or musculoskeletal injury occurred in the 2 groups. Conclusion The diaphragm exercise program is safe and feasible for ICU patients with mechanical ventilation，which can improve diaphragm function，increase the success rate of weaning，and promote the rehabilitation of patients.

Key words: ICU, Mechanical Ventilation, Diaphragm Exercise, Rehabilitation Nursing

刘秀, 刘滨滨, 权明桃, 詹炜丽, 杨登碧, 张佳薪. ICU机械通气患者膈肌锻炼方案的构建及应用研究[J]. 中华护理杂志, 2023, 58(3): 261-267.

LIU Xiu, LIU Binbin, QUAN Mingtao, ZHAN Weili, YANG Dengbi, ZHANG Jiaxin. Construction and application of a diaphragm exercise program in patients with mechanical ventilation in ICU[J]. Chinese Journal of Nursing, 2023, 58(3): 261-267.

图/表 6

表1 ICU机械通气患者膈肌锻炼方案

Table 1 Diaphragm exercise program of mechanically ventilated patients in ICU

表2 两组一般资料比较

Table 2 Comparison of general data in the 2 groups

表3 两组吸气末膈肌厚度的比较（mm，$\bar{x}±s$）

Table 3 Comparison of DTei between the 2 groups（mm，$\bar{x}±s$）

表4 两组呼气末膈肌厚度的比较（mm，$\bar{x}±s$）

Table 4 Comparison of DTee between the 2 groups（mm，$\bar{x}±s$）

表5 两组膈肌增厚分数的比较（%，$\bar{x}±s$）

Table 5 Comparison of DTF between the 2 groups（%，$\bar{x}±s$）

表6 两组膈肌移动度的比较（mm，$\bar{x}±s$）

Table 6 Comparison of DE between the 2 groups（mm，$\bar{x}±s$）

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