神经肌肉电刺激与早期被动活动对机械通气患者ICU获得性虚弱的影响

关键词：ICU获得性虚弱  早期被动活动  神经肌肉电刺激  机械通气

Keywords:intensive care unit acquired weakness  early passive activity  neuromuscular electrical stimulation  mechanical ventilation

摘要：

      摘要 目的：探讨早期被动活动与神经肌肉电刺激（NMES）对机械通气患者ICU获得性虚弱（ICU-AW）的影响。 方法：前瞻性随机对照的研究方法，共纳入144例机械通气患者，按随机数字法分到对照组、活动组、NEMS组及联合组，监测机械通气后患者第1、3、5、7d肌力水平，并记录机械通气、入住ICU时间及总住院时间。 结果：相比对照组，其余三组患者肌力均有所改善，联合组肌力增加水平更显著且时间更早，第3天 MRC(Medical Research Council score，MRC-score)评分联合组即高于对照组（P<0.05）；而NMES组至第5天仅高于对照组（P<0.05）。各组患者ICU-AW患病率均呈上升趋势，但第7天时联合组患病率明显低于其余三组（患病率分别为55.26%、45.71%、33.33%、22.86%），第5、7天时的对照组与NMES组、联合组以及活动组与联合组的患病率有差异（P<0.05）。四组机械通气及入住ICU时间比较，联合组比对照组、活动组和NMES组比对照组均明显减少（P<0.05）；NMES组与联合组仅在机械通气时间中有差异（P<0.05）；各组总住院时间均无差异（P>0.05）。 结论：NMES与早期被动活动均可维持或改善患者肌力，使患者ICU-AW的患病率降低、机械通气时间和入住ICU时间减少，NMES的疗效优于手动被动干预，而联合组效果更加显著

Abstract:

      Abstract Objective: To investigate the effect of early passive activity and neuromuscular electrical stimulation (NMES) on ICU-acquired weakness (ICU-AW) in patients receiving mechanical ventilation. Method: A prospective randomized controlled study was conducted in 144 patients receiving mechanical ventilation. they were divided into control group, activity group, NMES group and combination group with the random number table. At the 1st, 3rd, 5th and 7th day after mechanical ventilation, muscle strength was monitored, and the duration of mechanical ventilation, ICU stay and hospital stay were recorded. Result: Comparing with the control group, muscle strength was improved in the other 3 groups. The increase of muscle strength in the combination group was more obvious and occurring earlier. At the 3rd day, Medical Research Council（MRC) score in the combination group was higher than that in the control group（P<0.05）. At the 5th day, MRC score in the NMES group was higher than that in the control group（P<0.05）. The incidence of ICU-AW in each group showed an upward trend. However, at the 7th day, the incidence was evidently lower in the combination group (22.86%) as compared with the other 3 groups (55.26%,45.71%,33.33%). At the 5th and 7th day, the incidence of NMES group was less than the control group（P<0.05），and the combination group was less than the control group and activity group （P<0.05）. Comparison among the 4 groups demonstrated that the duration of mechanical ventilation and ICU stay reduced significantly in the combination group than the control group and the activity group（P<0.05）, as well as in the NMES group than the control group（P<0.05）. Comparison between the NMES group and the combination group showed a difference only in the duration of mechanical ventilation. The duration of hospital stay presented no differences among each group（P>0.05）. Conclusion: Both early passive activity and NMES can maintain or improve patients’ muscle strength, reduce the incidence of ICU-AW and the duration of mechanical ventilation and ICU stay. Additionally, the efficacy of NMES is superior to manual passive intervention, and the efficacy in the combination group is more significant.