虚拟现实技术在ICU患者早期活动中的应用研究

doi:10.3761/j.issn.0254-1769.2023.09.004

摘要/Abstract

摘要：

目的分析虚拟现实技术在ICU患者早期活动中的应用效果。方法 2021年11月—2022年1月，采用便利抽样法，选取上海市某三级甲等医院ICU收治的76例患者作为研究对象，根据随机数字表法将患者分为试验组和对照组。试验组在常规护理的基础上通过虚拟现实技术进行早期活动；对照组进行常规早期活动，比较两组医学研究委员会评分、握力和每次运动时长、ICU住院时间、风险事件的差异。结果 68例患者完成了该研究，试验组37例，对照组31例。试验组ICU获得性衰弱发生率（13.50%）低于对照组（35.50%），试验组医学研究委员会评分为（57.08±3.24）分，高于对照组（55.74±4.28）分；试验组每次运动时长为（19.78±4.90） min，高于对照组（14.94±6.78） min，试验组ICU住院时长为（4.65±2.82） d，低于对照组（6.90±2.40） d，差异均有统计学意义（P<0.05）；但试验组握力与对照组相比，差异无统计学意义（P=0.393）。结论虚拟现实技术有助于ICU患者早期活动，预防ICU获得性衰弱，缩短ICU住院时长，促进患者康复。

关键词: 虚拟现实技术, 危重症, 早期活动, ICU获得性衰弱, 护理

Abstract:

Objective To investigate the application effects of virtual reality technology in early activities of critically ill patients. Methods From November 2021 to January 2022，76 patients in the surgical intensive care unit of a tertiary A hospital in Shanghai were selected as the research subjects and divided into an experimental group and a control group according to the random number table method. The control group was given routine early activities，and the experimental group was given early activity intervention through virtual reality technology. The Medical Research Council score，grip strength，the duration of exercise，the length of ICU stay and risk events were observed and compared between the 2 groups. Results 68 ICU patients completed the study. The incidence of ICU-acquired weakness in the experimental group（13.50%） was lower than that in the control group（35.50%），and the muscle strength score of（57.08±3.24） by Medical Research Council in the experimental group was higher than that of（55.74±4.28） in the control group. The duration of exercise in the experimental group was （19.78±4.90） minutes，which was higher than that of （14.94±6.78） minutes in the control group. The length of ICU stay in the experimental group was（4.65±2.82） days，which was lower than that of（6.90±2.40） days in the control group，and the differences were statistically significant（P<0.05）. There was no significant difference in grip strength between the experimental group and the control group（P=0.393）. Conclusion Virtual reality technology can help ICU patients with their early activities，improve their muscle strength，prevent ICU-acquired weakness，reduce length of ICU stay， and promote rehabilitation of patients.

Key words: Virtual Reality, Critical Illness, Early Activities, Intensive Care Unit-Acquired Weakness, Nursing Care

夏艳玲, 潘文彦, 赵洋洋, 陈志炜, 蔡诗凝, 唐颖嘉, 金喆. 虚拟现实技术在ICU患者早期活动中的应用研究[J]. 中华护理杂志, 2023, 58(9): 1050-1055.

XIA Yanling, PAN Wenyan, ZHAO Yangyang, CHEN Zhiwei, CAI Shining, TANG Yingjia, JIN Zhe. Application of virtual reality technology in early activities of ICU patients[J]. Chinese Journal of Nursing, 2023, 58(9): 1050-1055.

图/表 3

表1 两组一般资料的比较

Table 1 Comparison of baseline data between 2 groups

表2 两组ICU获得性衰弱发生情况比较[例（百分比，%）]

Table 2 Comparison of the incidence of ICU-AW between 2 groups[case（percentage，%）]

表3 两组医学研究委员会评分、握力比较（

\bar{x} \pm s

）

Table 3 Comparison of MRC muscle strength and grip strength between 2 groups（

\bar{x} \pm s

）

表3 两组医学研究委员会评分、握力比较（ $\bar{x} \pm s$ ）

Table 3 Comparison of MRC muscle strength and grip strength between 2 groups（ $\bar{x} \pm s$ ）

参考文献 26

[1]	Zhou WD, Shi BS, Fan YY, et al. Effect of early activity combined with early nutrition on acquired weakness in ICU patients[J]. Medicine(Baltimore), 2020, 99(29):e21282.
[2]	Taito S, Shime N, Yasuda H, et al. Out-of-bed mobilization of patients undergoing mechanical ventilation with orotracheal tubes:a survey study[J]. J Crit Care, 2018, 47:173-177. DOI URL
[3]	刘美华, 彭剑雄, 罗翠, 等. 机械通气患儿早期活动方案的构建及应用研究[J]. 中华护理杂志, 2022, 57(8):901-907. DOI
	Liu MH, Peng JX, Luo C, et al. Construction and application of an early activity program in children with mechanical ventilation[J]. Chin J Nurs, 2022, 57(8):901-907. DOI
[4]	田然, 柏敏, 马腾. 虚拟现实技术对脑卒中患者上肢功能及日常生活活动能力的效果[J]. 中国康复理论与实践, 2016, 22(12):1371-1374. DOI
	Tian R, Bai M, Ma T. Effect of virtual reality technology on upper limbs function and activities of daily living in stroke patients[J]. Chin J Rehabil Theory Pract, 2016, 22(12):1371-1374.
[5]	Zhang L, Hu WS, Cai ZY, et al. Early mobilization of critically ill patients in the intensive care unit:a systematic review and Meta-analysis[J]. PLoS One, 2019, 14(10):e0223185. DOI URL
[6]	栾琳琳, 丁敏, 卢振玲, 等. 虚拟现实技术在ICU危重症患者中的应用进展[J]. 中华护理杂志, 2021, 56(8):1255-1260. DOI
	Luan LL, Ding M, Lu ZL, et al. Application progress of virtual reality technology in ICU critically ill patients[J]. Chin J Nurs, 2021, 56(8):1255-1260. DOI
[7]	赵一瑾, 余彬, 何龙龙, 等. 虚拟现实技术结合作业治疗训练对脑卒中偏瘫患者上肢功能影响的临床研究[J]. 中国康复医学杂志, 2019, 34(6):661-666.
	Zhao YJ, Yu B, He LL, et al. Effects of virtual reality technology combined with occupational therapy training on upper limb function in stroke patients with hemiplegia[J]. Chin J Rehabil Med, 2019, 34(6):661-666.
[8]	Norouzi-Gheidari N, Hernandez A, Archambault PS, et al. Feasibility,safety and efficacy of a virtual reality exergame system to supplement upper extremity rehabilitation post-stroke:a pilot randomized clinical trial and proof of principle[J]. Int J Environ Res Public Health, 2019, 17(1):113. DOI URL
[9]	Lei C, Sunzi K, Dai FL, et al. Effects of virtual reality rehabilitation training on gait and balance in patients with Parkinson’s disease:a systematic review[J]. PLoS One, 2019, 14(11):e0224819. DOI URL
[10]	张芳芳, 杨海燕, 伍珺. 超早期康复训练对脑卒中病人神经生化标志物水平和运动功能的影响[J]. 护理研究, 2019, 33(6):1065-1068.
	Zhang FF, Yang HY, Wu J. Effect of ultra-early rehabilitation training on neurobiochemical markers and motor function in stroke patients[J]. Chin Nurs Res, 2019, 33(6):1065-1068.
[11]	Kramer CL. Intensive care unit-acquired weakness[J]. Neurol Clin, 2017, 35(4):723-736. DOI PMID
[12]	付丽, 金艳鸿, 钟丽霞, 等. 重症监护室患者早期活动临床实践指南与共识的质量评价[J]. 护士进修杂志, 2022, 37(14):1249-1254,1261.
	Fu L, Jin YH, Zhong LX, et al. Quality appraisal of clinical guideline and consensus on early exercise management for patients in intensive care units[J]. J Nurses Train, 2022, 37(14):1249-1254,1261.
[13]	丁韫晗, 罗健, 熊莉娟, 等. ICU获得性衰弱患者早期活动的最佳证据总结[J]. 护理学杂志, 2021, 36(24):34-38.
	Ding YH, Luo J, Xiong LJ, et al. Best evidence summary of early activities for patients with ICU acquired weakness[J]. J Nurs Sci, 2021, 36(24):34-38.
[14]	胥露, 江智霞, 鲁鑫, 等. 早期功能锻炼预防ICU获得性衰弱的研究进展[J]. 中华护理杂志, 2021, 56(8):1267-1271. DOI
	Xu L, Jiang ZX, Lu X, et al. Early functional exercise to prevent adult ICU acquired weakness:a system review[J]. Chin J Nurs, 2021, 56(8):1267-1271. DOI
[15]	吉婷, 张金萍, 陈菁, 等. 早期被动活动在机械通气患者ICU获得性虚弱中的临床研究[J]. 护士进修杂志, 2020, 35(2):134-137.
	Ji T, Zhang JP, Chen J, et al. Clinical study of early passive activity in acquired weakness of ICU in patients with mechanical ventilation[J]. J Nurses Train, 2020, 35(2):134-137.
[16]	Paternostro-Sluga T, Grim-Stieger M, Posch M, et al. Reliability and validity of the Medical Research Council(MRC) Scale and a modified scale for testing muscle strength in patients with radial palsy[J]. J Rehabil Med, 2008, 40(8):665-671. DOI PMID
[17]	Nydahl P, Sricharoenchai T, Chandra S, et al. Safety of patient mobilization and rehabilitation in the intensive care unit:systematic review with meta-analysis[J]. Ann Am Thorac Soc, 2017, 14(5):766-777. DOI PMID
[18]	石沉默, 张帅. 基于保护动机理论的早期康复运动对危重症患者ICU获得性衰弱的效果分析[J]. 护理管理杂志, 2019, 19(4):255-258.
	Shi CM, Zhang S. Effect of early rehabilitation exercise based on protection motivation theory on ICU-acquired weakness among critically ill patients[J]. J Nurs Adm, 2019, 19(4):255-258.
[19]	Dettling-Ihnenfeldt DS, Wieske L, Horn J, et al. Functional recovery in patients with and without intensive care unit-acquired weakness[J]. Am J Phys Med Rehabil, 2017, 96(4):236-242. DOI URL
[20]	Tang HB, Shrager JB. The signaling network resulting in ventilator-induced diaphragm dysfunction[J]. Am J Respir Cell Mol Biol, 2018, 59(4):417-427. DOI URL
[21]	Wollersheim T, Woehlecke J, Krebs M, et al. Dynamics of myosin degradation in intensive care unit-acquired weakness during severe critical illness[J]. Intensive Care Med, 2014, 40(4):528-538. DOI PMID
[22]	Cullen ML, Casazza GA, Davis BA. Passive recovery strategies after exercise:a narrative literature review of the current evidence[J]. Curr Sports Med Rep, 2021, 20(7):351-358. DOI URL
[23]	Calabrò RS, Naro A, Russo M, et al. The role of virtual reality in improving motor performance as revealed by EEG:a randomized clinical trial[J]. J Neuroeng Rehabil, 2017, 14(1):53. DOI URL
[24]	Saposnik G, Cohen LG, Mamdani M, et al. Efficacy and safety of non-immersive virtual reality exercising in stroke rehabilitation(EVREST):a randomised,multicentre,single-blind,controlled trial[J]. Lancet Neurol, 2016, 15(10):1019-1027. DOI PMID
[25]	陈姣, 梁万添, 汤周全, 等. 虚拟现实技术结合真实日常功能训练对脑卒中后上肢功能与心理状况的影响[J]. 吉林医学, 2022, 43(9):2496-2498.
	Chen J, Liang WT, Tang ZQ, et al. Effect of virtual reality technology combined with real daily functional training on upper limb function and psychological status after stroke[J]. Jilin Med J, 2022, 43(9):2496-2498.
[26]	吴娟. 早期目标导向活动对预防RICU机械通气患者ICU-AW的效果研究[D]. 长沙: 湖南师范大学, 2019.
	Wu J. Effect of early goal-directed mobilisation on prevention of ICU acquired weakness in RICU patients with mechanical ventilation[D]. Changsha: Hunan Normal University, 2019.

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