Construction and application of early rehabilitation scheme for Intensive Care Unit patients

doi:10.3761/j.issn.0254-1769.2020.01.001

Abstract

Abstract:

Objective To construct and implement the early rehabilitation scheme for prevention of Intensive Care Unit acquired weakness（ICU-AW） in order to reduce the incidence of ICU-AW and improve clinical nursing outcomes of ICU patients. Methods Literature analysis and Delphi method were applied to construct the early rehabilitation scheme for prevention of ICU-AW. 70 patients admitted in one comprehensive ICU at a tertiary hospital in Anhui Province from October 2018 to April 2019 were randomly divided into an experimental group and a control group （35 patients in each group）. The control group was given routine rehabilitation nursing in ICU,while the experimental group was given the early rehabilitation scheme developed in this study. After intervention,Medical Research Council（MRC） muscle strength assessment,Barthel index evaluation form,the incidence of ICU-AW and the length of ICU stay were used to evaluate the effects of intervention. Results The constructed scheme contained four parts,including early exercise,psychological nursing,nutrition support and effect evaluation,and 32 specific rehabilitation contents. In this study,the muscle strength and Barthel index score of the experimental group were significantly higher than those in the control group（P<0.001） on the day of ICU discharge;the length of ICU stay was shorter in the experimental group（P<0.05）;the incidence of ICU-AW was significantly lower than that in the control group（P<0.05）. Conclusion The constructed early rehabilitation scheme for the prevention of ICU-AW is scientific and reliable. The implementation of the scheme can decrease the incidence of ICU-AW and improve the clinical nursing outcomes of patients.

Key words: Delphi Technique, Critical Illness, Intensive Care Unit Acquired Weakness, Rehabilitation Nursing

摘要：

目的构建并应用ICU患者早期康复方案,以降低ICU获得性衰弱（intensive care unit acquired weakness,ICU-AW）的发生率,改善ICU患者的临床结局。方法运用文献分析法和Delphi法构建ICU患者早期康复方案,将70例于2018年10月—2019年4月入住安徽省某三级甲等医院综合ICU的患者随机分为试验组和对照组,每组各35例,试验组按本研究制订的方案进行康复,对照组按ICU护理常规进行康复,干预后采用英国医学研究委员会（Medical Research Council,MRC）肌力评定法、Barthel指数评定表、ICU-AW的发生率、ICU住院时间评估两组的干预效果。结果本研究构建的ICU患者早期康复方案包括早期运动、心理护理、营养支持、效果评价4个部分,32项具体康复内容。试验组转出ICU当天的肌力、Barthel指数评分均显著高于对照组（P<0.001）,ICU住院时间短于对照组（P<0.05）,ICU-AW的发生率显著低于对照组（P<0.05）。结论本研究构建的ICU患者早期康复方案具有较强的科学性和可靠性,应用该方案能降低ICU-AW的发生率,改善患者的临床护理结局。

关键词: 德尔菲技术, 危重症, ICU获得性衰弱, 康复护理

HAN Runing, LI Xiuchuan, ZHAO Shibing, LI Yajun, CHEN Lianfang, DUAN Huan, YANG Tingting. Construction and application of early rehabilitation scheme for Intensive Care Unit patients[J]. Chinese Journal of Nursing, 2020, 55(1): 8-15.

韩汝宁, 李秀川, 赵士兵, 李亚军, 陈莲芳, 段缓, 杨婷婷. 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.

Figures/Tables 5

References 30

[1]	Fan E, Cheek F Chlan L , et a1. An official American thracic 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]	Pati S, Goodfellow JA, Iyadurai S , et al. Approach to critical illness polyneuropathy and myopathy[J]. Postgrad Med J, 2008,84(993):354-360.
[3]	Fan E, Dowdy DW, Colantuoni E , et al. Physical complications in acute lung injury survivors:a two-year longitudinal prospective study[J]. Crit Care Med, 2014,42(4):849-859.
[4]	Zorowitz RD . ICU-acquired weakness:a rehabilitation perspective of diagnosis,treatment,and functional management[J]. Chest, 2016,150(4):966-971.
[5]	Hermans G, van den Berghe G . Clinical review:intensive care unit acquired weakness[J]. Crit Care, 2015,19(1):274-283.
[6]	Shepherd SJ, Newman R, Brett SJ , et al. Pharmacological therapy for the prevention and treatment of weakness after critical illness:a systematic reciew[J]. Crit Care Med, 2016,4(6):1198-1205.
[7]	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.
[8]	杨丽平 . ICU患者早期活动现状及影响因素分析[D]. 兰州:兰州大学, 2018.
[9]	周英凤, 顾莺, 胡雁 , 等. JBI循证卫生保健中心关于不同类型研究的质量评价工具——干预性研究的质量评价[J]. 护士进修杂志, 2018,33(1):24-26.
[10]	周英凤, 顾莺, 胡雁 , 等. JBI循证卫生保健中心关于不同类型研究的质量评价工具——干预性研究的质量评价[J]. 护士进修杂志, 2018,33(2):112-113.
[11]	俞玲娜 . 早期主动干预改善ICU获得性衰弱的研究[D]. 大连:大连医科大学, 2013.
[12]	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.
[13]	解雨 . 颈髓损伤机械通气患者肺康复方案的构建与临床应用研究[D]. 重庆:第三军医大学, 2017.
[14]	陈红 . 早期被动活动对机械通气患者ICU获得性虚弱的影响[D]. 石河子:石河子大学, 2017.
[15]	张爱梅, 丁爱萍, 陆烨华 . 早期活动预防慢性阻塞性肺疾病机械通气患者ICU获得性衰弱的效果[J]. 解放军护理杂志, 2017,34(15):1-5.
[16]	吴传芹 . ICU谵妄非药物集束化干预预防策略的构建与实证研究[D]. 南京:南京中医药大学, 2018.
[17]	Schweickert WD, Pohlman MC, Pohlman AS , et al. Early physical and occupational therapy in mechanically ventilated,critically ill patients:a randomized controlled trial[J]. Lancet, 2009, 373(9678):1874-1882.
[18]	Hodgson CL, Stiller K, Needham DM , et al. Expert consensus and recommendations on safety criteria for active mobilization of mechanically ventilated critically ill adults[J]. Crit Care, 2014,18(6):658.
[19]	Mcwilliams D, Weblin J, Atkins G , et al. Enhancing rehabilitation of mechanically ventilated patients in the intensive care unit:a quality improvement project[J]. J Crit Care, 2015,30(1):13-18.
[20]	Schaller SJ, Anstey M, Blobner M , et al. Early,goal-directed mobilisation in the surgical intensive care unit:a randomized controlled trial[J]. Lancet, 2016,388(10052):1377-1388.
[21]	McClave SA, Taylor BE, Martindale RG , et al. Guidelines for the provision and assessment of nutrition support therapy in the adult critically ill patient:Society of Critical Care Medicine(SCCM) and American Society for Parenteral and Enteral Nutrition(ASPEN)[J]. JPEN, 2016,40(2):159-211.
[22]	Leguina-Ruzzi, Alberto . A commentary on the 2015 Canadian clinical practice guidelines in glutamine supplementation to parenteral nutrition[J]. Crit Care, 2015,20(1):1-2.
[23]	陈向明 . 质的研究方法与社会科学研究[M]. 北京: 教育科学出版社, 2000.
[24]	吴明隆 . SPSS统计应用实务[M]. 北京: 科学出版社, 2003.
[25]	张文彤, 董伟 . SPSS统计分析高级教程[M]. 北京: 高等教育出版社, 2013.
[26]	Connolly BA, Jones GD, Curtis AA , et al. Clinical predictive value of manual muscle strength testing during critical illness:an observational cohort study[J]. Crit Care, 2013,17(5):221-229.
[27]	李奎成, 唐丹, 刘晓艳 , 等. 国内Barthel指数和改良Barthel指数应用的回顾性研究[J]. 中国康复医学杂志, 2009,24(8):737-740.
[28]	Zorowitz RD . ICU-acquired weakness:a rehabilitation perspective of diagnosis,treatment,and functional management[J]. Chest, 2016,150(4):966-971.
[29]	俞玲娜, 张娜, 尹安春 . ICU 获得性衰弱的干预研究现状[J]. 中华护理杂志, 2013,48(1):82-83.
[30]	查丽玲, 周松, 王建宁 . ICU护士对患者早期活动认知和行为的调查研究[J]. 中华护理杂志, 2018,53(2):221-225.