CAJ | 학술논문

目的探讨机械通气患者进行早期康复训练对预后的影响.方法前瞻性随机对照实验研究,选择2010年5月至2012年5月在青岛大学医学院附属医院重症医学科收治的机械通气时间大于48 h少于72 h的60例患者,随机(随机数字法)分为康复训练组和对照组,每组各30例.康复训练组患者每日进行两次康复训练,康复训练的时间和强度根据患者病情调整,早期康复训练包括主动抬头、由平卧位到坐位、端坐床边、床旁坐位、床旁站立和床旁行走.比较康复训练组和对照组患者的体质量指数、首次床旁坐位时间、机械通气时间、ICU住院时间、APACHEⅡ评分、最高FiO2、最低PaO2/ FiO2和住院病死率.组间差异比较采用成组t检验.结果两组患者的体质量指数、APACHEⅡ评分、最高FiO2、最低PaO2/ FiO2和住院病死率差异无统计学意义(P均＞0.05),康复训练组的首次床旁坐位时间(3.8±1.2)d、机械通气时间(5.6±2.1)d、ICU住院时间(7.3±2.8)d与对照组的首次床旁坐位时间(14.9±4.7)d、机械通气时间(12.7±4.1)d、ICU住院时间(15.2±4.5)d相比较均明显缩短(P均＜0.05).结论本研究表明机械通气患者在重症医学科住院期间进行早期康复训练安全有效,可明显缩短机械通气时间、ICU住院时间和改善患者的预后.
목적 탐토궤계통기환자진행조기강복훈련대예후적영향.방법 전첨성수궤대조실험연구,선택2010년5월지2012년5월재청도대학의학원부속의원중증의학과수치적궤계통기시간대우48 h소우72 h적60례환자,수궤(수궤수자법)분위강복훈련조화대조조,매조각30례.강복훈련조환자매일진행량차강복훈련,강복훈련적시간화강도근거환자병정조정,조기강복훈련포괄주동태두、유평와위도좌위、단좌상변、상방좌위、상방참립화상방행주.비교강복훈련조화대조조환자적체질량지수、수차상방좌위시간、궤계통기시간、ICU주원시간、APACHEⅡ평분、최고FiO2、최저PaO2/ FiO2화주원병사솔.조간차이비교채용성조t검험.결과 량조환자적체질량지수、APACHEⅡ평분、최고FiO2、최저PaO2/ FiO2화주원병사솔차이무통계학의의(P균＞0.05),강복훈련조적수차상방좌위시간(3.8±1.2)d、궤계통기시간(5.6±2.1)d、ICU주원시간(7.3±2.8)d여대조조적수차상방좌위시간(14.9±4.7)d、궤계통기시간(12.7±4.1)d、ICU주원시간(15.2±4.5)d상비교균명현축단(P균＜0.05).결론 본연구표명궤계통기환자재중증의학과주원기간진행조기강복훈련안전유효,가명현축단궤계통기시간、ICU주원시간화개선환자적예후.
Objective To investigate the effects of early rehabilitation therapy in mechanically ventilated ICU in patients.Methods A randomized controlled trial was carried out.Sixty mechanically ventilated patients,with tracheal intubation or tracheostomy more than 48 h and less than 72 h,were admitted to the intensive care unit (ICU) of the Affiliated Hospital of Medical College Qingdao University from May 2010 to May 2012.These patients were randomly (random number) divided into two groups,the rehabilitation group and the control group,30 patients in each group.In rehabilitation group,rehabilitation therapy was taken twice daily,and the training time and intensity was adjusted according to the condition of the patients.Early rehabilitation therapy included head up actively,transfer from the supine to sit,out of bed,transfer to a chair,standing bedside bed and walking bedside bed.The patient' s body mass index,days to first out of bed,duration of mechanical ventilation,ICU stay,APACHE Ⅱ score,highest FiO2,lowest PaO2/FiO2 and hospital mortality of patients were compared between rehabilitation group and control group.The differences between the groups were compared using t test.Results There was no significant difference in body mass index,APACHE Ⅱ score,highest FiO2,lowest PaO2/FiO2 and hospital mortality between rehabilitation group and control group (P ＞ 0.05).Patients in the rehabilitation group had shorter first out of bed time [(3.8 ± 1.2) d vs.(14.9 ±4.7) d; P =0.00],duration of mechanical ventilation [(5.6±2.1) dvs.(12.7±4.1) d; P=0.005] andICUstay [(7.3±2.8) dvs.(15.2±4.5) d;P =0.01] compared with control group.Conclusions Early rehabilitation therapy was safe and effective in improving the outcomes of mechanical ventilation patient.