早期中西医结合集束化策略预防ICU获得性衰弱的干预研究
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摘要
目的探讨早期中西医结合集束化干预策略对预防ICU获得性衰弱(ICU-AW)的应用效果。方法收集2017年1月-2018年1月在新疆某三甲医院综合ICU住院并符合入选标准的患者,按照入院顺序先后分为试验组和对照组,其中对照组47例,试验组43例。对照组常规给予四肢被动活动和功能锻炼,试验组采用早期中西医结合集束化策略实施干预。比较2组患者ICU获得性衰弱的发生情况、BI指数、APACHE II评分、ICU住院天数以及住院总天数的差异。结果试验组患者ICU-AW发生率较对照组低;ICU住院天数和住院总天数比对照组短,BI指数及APACHE II评分比对照组高,差异均有统计学意义(P<0.05)。结论与常规护理措施比较,早期中西医结合集束化干预策略能有效降低ICU-AW发生率,提高患者日常生活活动能力,促进预后,缩短住院时间。
Objective To understand the current status of ICU acquired asthenia(ICU-AW) in comprehensive ICU, and to explore the effect of the early integration of TCM and Western Medicine on the prevention of ICU acquired weakness(ICU-AW). Methods 47 patients and 43 patients were divided into experimental group and control group respectively according to the admission order,which were hospitalized in a general ICU of a third-level hospital in Xinjiang, from January 2017 to January 2018. The control group was given limb passive activity and functional exercise routinely, while the experimental group was given early integrated traditional Chinese and Western medicine cluster strategy for intervention. The incidence of ICU-AW, BI index, APACHE II score, ICU hospitalization days and total hospitalization days were compared between the two groups. Results The incidence of ICU acquired asthenia in the intervention group was lower than that in the control group; the MRC-Score and the BI score were higher than the control group; the time of mechanical ventilation and the time of the ICU hospitalization were shorter than those of the control group,and the difference was statistically significant(P<0.05). Conclusion Compared with the conventional nursing measures, early intervention of integrated method of traditional Chinese and Western medicine could effectively reduce the incidence of ICU-AW and improve the activities of daily living of patients, improve prognosis, shorten the time of hospitalization.
Objective To understand the current status of ICU acquired asthenia(ICU-AW) in comprehensive ICU, and to explore the effect of the early integration of TCM and Western Medicine on the prevention of ICU acquired weakness(ICU-AW). Methods 47 patients and 43 patients were divided into experimental group and control group respectively according to the admission order,which were hospitalized in a general ICU of a third-level hospital in Xinjiang, from January 2017 to January 2018. The control group was given limb passive activity and functional exercise routinely, while the experimental group was given early integrated traditional Chinese and Western medicine cluster strategy for intervention. The incidence of ICU-AW, BI index, APACHE II score, ICU hospitalization days and total hospitalization days were compared between the two groups. Results The incidence of ICU acquired asthenia in the intervention group was lower than that in the control group; the MRC-Score and the BI score were higher than the control group; the time of mechanical ventilation and the time of the ICU hospitalization were shorter than those of the control group,and the difference was statistically significant(P<0.05). Conclusion Compared with the conventional nursing measures, early intervention of integrated method of traditional Chinese and Western medicine could effectively reduce the incidence of ICU-AW and improve the activities of daily living of patients, improve prognosis, shorten the time of hospitalization.
引文
[1] 李苗苗,罗健,谢霖,等.预防ICU获得性谵妄和获得性衰弱的集束化策略研究进展[J].中华护理杂志,2018,53(3):358-362.
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[11] 董小余,盛苗苗,方少样.ICU获得性衰弱对重症患者近远期预后的影响[J].护士进修杂志,2017(22):2025-2027.
[12] 陈新国,徐建国.ICU获得性肌无力的高危因素分析及其对预后的影响[J].浙江医学,2018,40(6):582-585.
[13] 何务晶,黄玉莲,李艳芳,等.分级康复训练对ICU机械通气患者肌力衰弱、压疮的影响[J].护理实践与研究,2018,15(5):155-157.
[14] 张莉,高晶,侯芳,等.基于数字ICU重点指标集束化监测的管理模式在护理质量改进中的应用[J].中国实用护理杂志,2018,34(15):1144-1149.
[15] 张文婷,高媛媛.多学科护理在ICU重度颅脑损伤合并肺部感染患者中的应用研究[J].护理实践与研究,2018,15(10):1-4.
[16] 许叶华,田丰,孙妍.ICU后综合征护理干预的研究进展[J].中华现代护理杂志,2018,24(15):1853-1856.
[17] 刘浩,张宏,高燕,等.集束化护理对ICU呼吸机相关性肺炎的干预效果及对患者满意度的影响[J].河北医药,2018(8):1273-1276.
[18] DAREN K,RENEE D,MOURTZAKIS M,et al.Combining nutrition and exercise to optimize survival and recovery from critical illness:Conceptual and methodological issues[J].Clin Nutr,2016,35(5):1-11.
[19] BOUJU P,TADI?J M,BARBAROT N,et al.Clinical assessment and train-of-four measurements in critically ill patients treated with recommended doses of cisatracurium or atracurium for neuromuscular blockade:a prospective descriptive study[J].Annal Intensive Care,2017,7(1):7-10.
[20] WINKELMAN C.The role of inflammation in ICU-acquired weakness[J].Crit Care,2010,14(4):186-187.
[2] 张秀华,孙桂华.ICU获得性衰弱的危险因素以及对患者近远期预后的影响[J].解放军护理杂志,2018,(12):39-42.
[3] 王静净.早期活动联合体感音乐预防ICU机械通气患者ICU-AW护理研究[J].河北医药,2018,40(2):306-309,313.
[4] 杨丽平,张志刚,张彩云,等.早期活动对ICU获得性衰弱干预效果的Meta分析[J].解放军护理杂志,2018 (5):1-7.
[5] WIESKE L,VERHAMME C,WITTEVEEN E,et al.Feasibility and diagnostic of early electrophysiological recordings for ICU-acquired weakness:an observational cohort study[J].Neurocrit Care,2015,22(3):385-394.
[6] WIESKE L,VERHAMME C,SCHULTZ M J,et al.Autonomic dysfunction in ICU-acquired weakness:a prospective observational pilot study[J].Intensive Care Med,2013,39(9):1610-1617.
[7] MICHAEL P.Muscle weakness and nutrition therapy in ICU[J].Curr Opin Clin Nut Metab Care,2015,18(2):150-154.
[8] 李亚玲,杨宝义,汪蓉.早期康复治疗对预防危重症患者ICU获得性衰弱的影响[J].中华现代护理杂志,2018,24(1):56-58.
[9] 王昌雪,韩静,张靓,等.ICU 获得性衰弱及相关护理干预[J].解放军护理杂志,2016,33(18):55-58.
[10] 张继兰.渐进性运动对ICU脑出血机械通气患者的影响[J].齐鲁护理杂志,2018 (10):1-3.
[11] 董小余,盛苗苗,方少样.ICU获得性衰弱对重症患者近远期预后的影响[J].护士进修杂志,2017(22):2025-2027.
[12] 陈新国,徐建国.ICU获得性肌无力的高危因素分析及其对预后的影响[J].浙江医学,2018,40(6):582-585.
[13] 何务晶,黄玉莲,李艳芳,等.分级康复训练对ICU机械通气患者肌力衰弱、压疮的影响[J].护理实践与研究,2018,15(5):155-157.
[14] 张莉,高晶,侯芳,等.基于数字ICU重点指标集束化监测的管理模式在护理质量改进中的应用[J].中国实用护理杂志,2018,34(15):1144-1149.
[15] 张文婷,高媛媛.多学科护理在ICU重度颅脑损伤合并肺部感染患者中的应用研究[J].护理实践与研究,2018,15(10):1-4.
[16] 许叶华,田丰,孙妍.ICU后综合征护理干预的研究进展[J].中华现代护理杂志,2018,24(15):1853-1856.
[17] 刘浩,张宏,高燕,等.集束化护理对ICU呼吸机相关性肺炎的干预效果及对患者满意度的影响[J].河北医药,2018(8):1273-1276.
[18] DAREN K,RENEE D,MOURTZAKIS M,et al.Combining nutrition and exercise to optimize survival and recovery from critical illness:Conceptual and methodological issues[J].Clin Nutr,2016,35(5):1-11.
[19] BOUJU P,TADI?J M,BARBAROT N,et al.Clinical assessment and train-of-four measurements in critically ill patients treated with recommended doses of cisatracurium or atracurium for neuromuscular blockade:a prospective descriptive study[J].Annal Intensive Care,2017,7(1):7-10.
[20] WINKELMAN C.The role of inflammation in ICU-acquired weakness[J].Crit Care,2010,14(4):186-187.