神经肌肉电刺激对ICU机械通气病人影响的Meta分析
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摘要
[目的]系统评价神经肌肉电刺激(NMES)对重症监护室(ICU)机械通气病人的影响。[方法]计算机检索PubMed、EMBASE、Cochrane Library、Web of Science、CINAHL、Physiotherapy Evidence Database(PEDro)、中国生物医学文献数据库(CBMdisc)、中国知网(CNKI)、维普中文科技期刊数据库(VIP)及万方数据库关于ICU机械通气病人行NMES的随机对照试验,经筛选文献,提取资料与评价质量后采用RevMan 5.3软件进行Meta分析。[结果]共纳入5项随机对照试验研究,Meta分析结果显示,与常规护理相比,NMES在增强ICU机械通气病人肌力[MD=1.14,95%CI(-0.32,2.61),P=0.13]及手握力[MD=2.20,95%CI(-6.32,10.73),P=0.61]、缩短机械通气时间[MD=-1.35,95%CI(-3.04,0.34),P=0.12]及ICU入住时间[MD=-4.68,95%CI(-9.41,0.05),P=0.05]、降低ICU死亡率[RR=1.10,95%CI(0.49,2.45),P=0.82]、提高成功脱机率[RR=1.14,95%CI(0.90,1.46),P=0.28]方面均未见明显优势,合并效应无统计学意义(P>0.05)。[结论]ICU机械通气病人行NMES对其肌力、手握力、机械通气时间、ICU住时间、ICU死亡率等无明显影响,未来尚需进行大样本、高质量、多中心的随机对照实验加以论证研究结果。
Objective:To systematically evaluate the influence of neuromuscular electrical stimulation(NMES)on mechanical ventilation in intensive care unit(ICU)patients.Methods:Randomized controlled trials for patients with ICU mechanical ventilation receiving NMES were in PubMed,EMBASE,Cochrane Library,Web of Science,CINAHL,Physiotherapy Evidence Database(PEDro),Chinese biomedical literature Database(CBMdisc),CNKI,VIP and Wanfang databases.Meta analysis was performed by RevMan 5.3 software after data extraction and quality evaluation.Results:A total of 5 randomized controlled trials were included and Meta analysis results showed that compared with the conventional nursing,NMES strength in strengthen ICU mechanical ventilation patients[MD=1.14,95% CI(-0.32,2.61),P=0.13)],hand grip strength[MD=2.20,95% CI(-6.32,10.73),P=0.61)],and shorten the time of mechanical ventilation[MD=-1.35,95% CI(-3.04,0.34),P=0.12)]and ICU stay time[MD=-4.68,95%CI(-9.41,0.05),P=0.05].There were no significant advantages in,reduction of ICU mortality[RR=1.10,95% CI(0.49,2.45),P=0.82],and probability of successful escape[RR=1.14,95% CI(0.90,1.46),P=0.28],and the combined effect was not statistically significant(P>0.05).Conclusions:NMES had no significant effect on muscle strength,hand grip strength,mechanical ventilation time,ICU duration of stay,and ICU mortality of ICU patients undergoing mechanical ventilation.In the future,large sample,high-quality,multi-center randomized controlled experiments were needed to verify the research results.
Objective:To systematically evaluate the influence of neuromuscular electrical stimulation(NMES)on mechanical ventilation in intensive care unit(ICU)patients.Methods:Randomized controlled trials for patients with ICU mechanical ventilation receiving NMES were in PubMed,EMBASE,Cochrane Library,Web of Science,CINAHL,Physiotherapy Evidence Database(PEDro),Chinese biomedical literature Database(CBMdisc),CNKI,VIP and Wanfang databases.Meta analysis was performed by RevMan 5.3 software after data extraction and quality evaluation.Results:A total of 5 randomized controlled trials were included and Meta analysis results showed that compared with the conventional nursing,NMES strength in strengthen ICU mechanical ventilation patients[MD=1.14,95% CI(-0.32,2.61),P=0.13)],hand grip strength[MD=2.20,95% CI(-6.32,10.73),P=0.61)],and shorten the time of mechanical ventilation[MD=-1.35,95% CI(-3.04,0.34),P=0.12)]and ICU stay time[MD=-4.68,95%CI(-9.41,0.05),P=0.05].There were no significant advantages in,reduction of ICU mortality[RR=1.10,95% CI(0.49,2.45),P=0.82],and probability of successful escape[RR=1.14,95% CI(0.90,1.46),P=0.28],and the combined effect was not statistically significant(P>0.05).Conclusions:NMES had no significant effect on muscle strength,hand grip strength,mechanical ventilation time,ICU duration of stay,and ICU mortality of ICU patients undergoing mechanical ventilation.In the future,large sample,high-quality,multi-center randomized controlled experiments were needed to verify the research results.
引文
[1] HORN J,HERMANS G.Intensive care unit-acquired weakness[J].Handb Clin Neurol,2017,141:531-543.
[2] ABDELMALIK P A,RAKOCEVIC G.Propofol as a risk factor for ICU-acquired weakness in septic patients with acute respiratory failure[J].Can J Neurol Sci,2017,44(3):295-303.
[3] BATT J,DOS SANTOS C C,CAMERON J I,et al.Intensive care unit-acquired weakness:clinical phenotypes and molecular mechanisms[J].Am J Respir Crit Care Med,2013,187(3):238-246.
[4] CAMERON S,BALL I,CEPINSKAS G,et al.Early mobilization in the critical care unit:a review of adult and pediatric literature[J].J Crit Care,2015,30(4):664-672.
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[6]岳萌,姚培宇,崔楚云,等.机械通气患者早期活动效果的系统评价[J].中华护理杂志,2016,51(5):551-557.YUE M,YAO P Y,CUI C Y,et al.Early mobilization for mechanically ventilated adult patients in the intensive care unit:a systematic review[J].Chinese Journal of Nursing,2016,51(5):551-557.
[7] DALL′ACQUA A M,SACHETTI A,SANTOS L J,et al.Use of neuromuscular electrical stimulation to preserve the thickness of abdominal and chest muscles of critically ill patients:a randomized clinical trial[J].J Rehabil Med,2017,49(1):40-48.
[8] DIRKS M L,HANSEN D,VAN ASSCHE A,et al.Neuromuscular electrical stimulation prevents muscle wasting in critically ill comatose patients[J].Clin Sci(Lond),2015,128(6):357-365.
[9] NUSSBAUM E L,HOUGHTON P,ANTHONY J,et al.Neuromuscular electrical stimulation for treatment of muscle impairment:critical review and recommendations for clinical practice[J].Physiother Can,2017,69(5):1-76.
[10] JPT H.Cochrane handbook for systematic reviews of interventions 5.1.0[R].London:The Cochrane Collaboration,2011:1.
[11] ABU-KHABER H A,ABOUELELA A M Z,ABDELKARIM E M.Effect of electrical muscle stimulation on prevention of ICU acquired muscle weakness and facilitating weaning from mechanical ventilation[J].Alexandria Journal of Medicine,2013,49(4):309-315.
[12] KHO M E,TRUONG A D,ZANNI J M,et al.Neuromuscular electrical stimulation in mechanically ventilated patients:a randomized,sham-controlled pilot trial with blinded outcome assessment[J].J Crit Care,2015,30(1):32-39.
[13] KARATZANOS E,GEROVASILI V,ZERVAKIS D,et al.Electrical muscle stimulation:an effective form of exercise and early mobilization to preserve muscle strength in critically ill patients[J].Crit Care Res Pract,2012,2012:432752.
[14] ROUTSI C,GEROVASILI V,VASILEIADIS I,et al.Electrical muscle stimulation prevents critical illness polyneuromyopathy:a randomized parallel intervention trial[J].Crit Care,2010,14(2):R74.
[15] VIVODTZEV I,DEBIGARE R,GAGNON P,et al.Functional and muscular effects of neuromuscular electrical stimulation in patients with severe COPD:a randomized clinical trial[J].Chest,2012,141(3):716-725.
[16] IWATSU K,IIDA Y,KONO Y,et al.Neuromuscular electrical stimulation may attenuate muscle proteolysis after cardiovascular surgery:apreliminary study[J].J Thorac Cardiovasc Surg,2017,153(2):373-379.
[17] ANGELOPOULOS E,KARATZANOS E,DIMOPOULOS S,et al.Acute microcirculatory effects of medium frequency versus high frequency neuromuscular electrical stimulation in critically ill patients-apilot study[J].Ann Intensive Care,2013,3(1):39.
[18]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.ZHAO G M,JIAO L L,YANG G H.The effects of early progressive exercise on ICU acquired weakness:a meta-analysis[J].Chinese Journal of Nursing,2017,52(2):177-181.
[19] PATSAKI I,GEROVASILI V,SIDIRAS G,et al.Effect of neuromuscular stimulation and individualized rehabilitation on muscle strength in intensive care unit survivors:a randomized trial[J].J Crit Care,2017,40:76-82.
[20] SILVA P E,BABAULT N,MAZULLO J B,et al.Safety and feasibility of a neuromuscular electrical stimulation chronaxie-based protocol in critical ill patients:aprospective observational study[J].J Crit Care,2017,37:141-148.
[21] SEGERS J,HERMANS G,BRUYNINCKX F,et al.Feasibility of neuromuscular electrical stimulation in critically ill patients[J].J Crit Care,2014,29(6):1082-1088.
[22] BAHADORI S,IMMINS T,WAINWRIGHT T W.The effect of calf neuromuscular electrical stimulation and intermittent pneumatic compression on thigh microcirculation[J].Microvasc Res,2017,111:37-41.
[2] ABDELMALIK P A,RAKOCEVIC G.Propofol as a risk factor for ICU-acquired weakness in septic patients with acute respiratory failure[J].Can J Neurol Sci,2017,44(3):295-303.
[3] BATT J,DOS SANTOS C C,CAMERON J I,et al.Intensive care unit-acquired weakness:clinical phenotypes and molecular mechanisms[J].Am J Respir Crit Care Med,2013,187(3):238-246.
[4] CAMERON S,BALL I,CEPINSKAS G,et al.Early mobilization in the critical care unit:a review of adult and pediatric literature[J].J Crit Care,2015,30(4):664-672.
[5] LAI C C,CHOU W,CHAN K S,et al.Early mobilization reduces duration of mechanical ventilation and intensive care unit stay in patients with acute respiratory failure[J].Arch Phys Med Rehabil,2017,98(5):931-939.
[6]岳萌,姚培宇,崔楚云,等.机械通气患者早期活动效果的系统评价[J].中华护理杂志,2016,51(5):551-557.YUE M,YAO P Y,CUI C Y,et al.Early mobilization for mechanically ventilated adult patients in the intensive care unit:a systematic review[J].Chinese Journal of Nursing,2016,51(5):551-557.
[7] DALL′ACQUA A M,SACHETTI A,SANTOS L J,et al.Use of neuromuscular electrical stimulation to preserve the thickness of abdominal and chest muscles of critically ill patients:a randomized clinical trial[J].J Rehabil Med,2017,49(1):40-48.
[8] DIRKS M L,HANSEN D,VAN ASSCHE A,et al.Neuromuscular electrical stimulation prevents muscle wasting in critically ill comatose patients[J].Clin Sci(Lond),2015,128(6):357-365.
[9] NUSSBAUM E L,HOUGHTON P,ANTHONY J,et al.Neuromuscular electrical stimulation for treatment of muscle impairment:critical review and recommendations for clinical practice[J].Physiother Can,2017,69(5):1-76.
[10] JPT H.Cochrane handbook for systematic reviews of interventions 5.1.0[R].London:The Cochrane Collaboration,2011:1.
[11] ABU-KHABER H A,ABOUELELA A M Z,ABDELKARIM E M.Effect of electrical muscle stimulation on prevention of ICU acquired muscle weakness and facilitating weaning from mechanical ventilation[J].Alexandria Journal of Medicine,2013,49(4):309-315.
[12] KHO M E,TRUONG A D,ZANNI J M,et al.Neuromuscular electrical stimulation in mechanically ventilated patients:a randomized,sham-controlled pilot trial with blinded outcome assessment[J].J Crit Care,2015,30(1):32-39.
[13] KARATZANOS E,GEROVASILI V,ZERVAKIS D,et al.Electrical muscle stimulation:an effective form of exercise and early mobilization to preserve muscle strength in critically ill patients[J].Crit Care Res Pract,2012,2012:432752.
[14] ROUTSI C,GEROVASILI V,VASILEIADIS I,et al.Electrical muscle stimulation prevents critical illness polyneuromyopathy:a randomized parallel intervention trial[J].Crit Care,2010,14(2):R74.
[15] VIVODTZEV I,DEBIGARE R,GAGNON P,et al.Functional and muscular effects of neuromuscular electrical stimulation in patients with severe COPD:a randomized clinical trial[J].Chest,2012,141(3):716-725.
[16] IWATSU K,IIDA Y,KONO Y,et al.Neuromuscular electrical stimulation may attenuate muscle proteolysis after cardiovascular surgery:apreliminary study[J].J Thorac Cardiovasc Surg,2017,153(2):373-379.
[17] ANGELOPOULOS E,KARATZANOS E,DIMOPOULOS S,et al.Acute microcirculatory effects of medium frequency versus high frequency neuromuscular electrical stimulation in critically ill patients-apilot study[J].Ann Intensive Care,2013,3(1):39.
[18]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.ZHAO G M,JIAO L L,YANG G H.The effects of early progressive exercise on ICU acquired weakness:a meta-analysis[J].Chinese Journal of Nursing,2017,52(2):177-181.
[19] PATSAKI I,GEROVASILI V,SIDIRAS G,et al.Effect of neuromuscular stimulation and individualized rehabilitation on muscle strength in intensive care unit survivors:a randomized trial[J].J Crit Care,2017,40:76-82.
[20] SILVA P E,BABAULT N,MAZULLO J B,et al.Safety and feasibility of a neuromuscular electrical stimulation chronaxie-based protocol in critical ill patients:aprospective observational study[J].J Crit Care,2017,37:141-148.
[21] SEGERS J,HERMANS G,BRUYNINCKX F,et al.Feasibility of neuromuscular electrical stimulation in critically ill patients[J].J Crit Care,2014,29(6):1082-1088.
[22] BAHADORI S,IMMINS T,WAINWRIGHT T W.The effect of calf neuromuscular electrical stimulation and intermittent pneumatic compression on thigh microcirculation[J].Microvasc Res,2017,111:37-41.