基于Roy适应模式的早期活动专项培训在重症监护病房机械通气患者中的应用效果
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摘要
目的观察基于Roy适应模式的早期活动专项培训在重症监护病房(ICU)机械通气患者中的应用效果及对ICU获得性衰弱(ICU-AW)和生存质量的影响。方法选择2017年1～12月新疆医科大学第一附属医院重症医学科接受治疗ICU机械通气患者84例,按照随机数字表法分为对照组(42例)和观察组(42例)。对照组给予常规模式的早期活动专项培训,观察组给予基于Roy适应模式的早期活动专项培训。分别采用医学研究委员会(MRC)评分和世界卫生组织生存质量测定量表简表(WHO QOL-BREF)评价肌力情况和生存质量。比较两组患者呼吸机使用天数、ICU入住天数、住院总天数、ICU-AW(ICU获得性衰弱)发生率、MRC评分及生存质量。结果观察组患者呼吸机使用天数、ICU入住天数、住院总天数少于对照组,差异有统计学意义(P <0.05)。转出ICU病房时,与对照组比较,观察组患者ICU-AW发生率降低,MRC评分升高,反映生存质量的生理、心理、社会、环境方面评分及总分升高,差异有统计学意义(P <0.05)。结论基于Roy适应模式的早期活动专项培训在ICU机械通气患者中应用效果良好,能够缩短机械通气及ICU入住时间,降低ICU-AW发生率,提高生存质量,临床上值得应用。
Objective To observe the application effect of special training for early activity based on Roy adaptation mode in Intensive Care Unit(ICU) patients with mechanical ventilation and its influences on ICU-acquired weakness(ICU-AW) and quality of life. Methods From January to December 2017, in Department of Critical Care Medicine, NO.1 Hospital Affiliated to Xinjiang Medical University, 84 ICU patients with mechanical ventilation who received therapy were selected, according to random number table method, they were divided into control group and observation group,with 42 cases in each group. The control group was given conventional mode of special training for early activity, while the observation group was given special training for early activity based on Roy adaptation mode, Medical Research Council(MRC) score and brief scale of WHO quality of life(WHO QOL-BREF) were employed to assess muscle strength and life of quality respectively. Then, days of use of ventilator, ICU treatment, the hospitalization, incidences of ICU-AW, MRC score and life of quality in the two groups were compared. Results The days of using ventilator, ICU treatment and hospitalization in the observation group were less than the control group, the differences were statistically significant(P < 0.05). When moving out of the ICU ward, compared with the control group, the observation group had lower incidence of ICU-AW and higher MRC scores, the differences were statistically significant(P < 0.05). As to life of quality, scores of physiology, psychology, society, circumstance and total scores that reflected life of quality in the observation group were higher than the control group when moving out of ICU ward, the differences were statistically significant(P < 0.05). Conclusion Special training for early activity based on Roy adaptation mode has well application effect on ICU patients with mechanical ventilation. It can shorten time of mechanical ventilation, ICU treatment, reduce incidence of ICU-AW and improve quality of life.
Objective To observe the application effect of special training for early activity based on Roy adaptation mode in Intensive Care Unit(ICU) patients with mechanical ventilation and its influences on ICU-acquired weakness(ICU-AW) and quality of life. Methods From January to December 2017, in Department of Critical Care Medicine, NO.1 Hospital Affiliated to Xinjiang Medical University, 84 ICU patients with mechanical ventilation who received therapy were selected, according to random number table method, they were divided into control group and observation group,with 42 cases in each group. The control group was given conventional mode of special training for early activity, while the observation group was given special training for early activity based on Roy adaptation mode, Medical Research Council(MRC) score and brief scale of WHO quality of life(WHO QOL-BREF) were employed to assess muscle strength and life of quality respectively. Then, days of use of ventilator, ICU treatment, the hospitalization, incidences of ICU-AW, MRC score and life of quality in the two groups were compared. Results The days of using ventilator, ICU treatment and hospitalization in the observation group were less than the control group, the differences were statistically significant(P < 0.05). When moving out of the ICU ward, compared with the control group, the observation group had lower incidence of ICU-AW and higher MRC scores, the differences were statistically significant(P < 0.05). As to life of quality, scores of physiology, psychology, society, circumstance and total scores that reflected life of quality in the observation group were higher than the control group when moving out of ICU ward, the differences were statistically significant(P < 0.05). Conclusion Special training for early activity based on Roy adaptation mode has well application effect on ICU patients with mechanical ventilation. It can shorten time of mechanical ventilation, ICU treatment, reduce incidence of ICU-AW and improve quality of life.
引文
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[13]杨丽平,张志刚,张彩云,等.机械通气患者早期主动活动效果的Meta分析[J].中国护理管理,2017,17(6):758-764.
[14] Letter MA,Schmitz PI,Visser LH,et al. Risk factors for the development of polyneuropathy and myopathy in critically ill patients[J]. Crit Care Med,2001,29(12):2281-2286.
[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):44-46.
[16]张莹,米元元.早期康复干预在预防ICU获得性衰弱中的研究进展[J].解放军护理杂志,2017,34(8):48-51.
[17]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.
[18]刘小平,胡秀红,王海英,等.Roy适应模式对妊娠高血压疾病患者身心状态的影响[J].蚌埠医学院学报,2016,41(1):109-112.
[19]孙建华,李云英,彭素清,等.基于Roy适应模式的中医护理方案在突发性耳聋患者中的运用效果分析[J].中医药导报,2016,31(12):110-112.
[20]季丽军. Roy适应模式对乳腺癌改良根治术后患者耻辱感及生存质量的影响[J].中华现代护理杂志,2017,23(17):2296-2298.
[21]陈荣,王建春,傅强.基于Roy模式的中医综合干预方案在结肠癌术后患者中的运用效果[J].中国医药导报,2016,13(16):82-85.
[22]龙艳波,章红,王晓利.基于Roy适应模式的支持护理方案在感音神经性耳聋患者中的应用效果[J].中国当代医药,2016,23(16):182-185.
[23]周燕,黄洁微.Roy适应模式在糖尿病足患者睡眠障碍护理中的应用[J].护士进修杂志,2016,31(4):328-331.
[2]庄一渝,韦秀霞,彭剑英,等.ICU过渡期护理临床实践与研究进展[J].中华护理杂志,2016,51(2):211-215.
[3] Jung B,Moury PH,Mahul M,et al. Diaphragmatic dysfunction in patients with ICU-acquired weakness and its impact on extubation failure[J]. Intens Care Med,2016,42(5):853.
[4]周茜,耿亚琴,狄捷,等.器械拉力操预防ICU获得性衰弱效果研究[J].护理学杂志,2016,31(17):18-20.
[5]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.
[6]周玥,黄叶莉,蔡伟萍,等.Roy适应模式理论体系及其应用现状[J].护理研究,2016,30(21):2577-2579.
[7] Balas MC,Vasilevskis EE,Burke WJ,et al. Critical care nurses′role implementing the “ABCDE bundle” into practice[J]. Crit Care Nurse,2012,32(2):35-38.
[8] Paternostrosluga T,Grimstieger M,Posch M,et al. Reliability and validity of the Medical Research Council(MRC)scale and a modified scale for testing muscle strength in patients with radial palsy[J]. J Rehabil Men,2008,40(8):665-671.
[9]武敬参,鄢秀英,王羽,等.健康调查简表与世界卫生组织生存质量测定量表简表在评价肺结核患者生存质量中的应用比较[J].华西医学,2016,31(3):463-466.
[10]柯卉,黄海燕.四级早期活动与康复锻炼疗法预防病人ICU获得性衰弱的效果观察[J].护理研究,2016,30(18):2202-2205.
[11]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.
[12]吴海珍,周洁.早期多元化护理干预对ICU获得性衰弱的影响[J].护理研究,2017,31(2):251-253.
[13]杨丽平,张志刚,张彩云,等.机械通气患者早期主动活动效果的Meta分析[J].中国护理管理,2017,17(6):758-764.
[14] Letter MA,Schmitz PI,Visser LH,et al. Risk factors for the development of polyneuropathy and myopathy in critically ill patients[J]. Crit Care Med,2001,29(12):2281-2286.
[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):44-46.
[16]张莹,米元元.早期康复干预在预防ICU获得性衰弱中的研究进展[J].解放军护理杂志,2017,34(8):48-51.
[17]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.
[18]刘小平,胡秀红,王海英,等.Roy适应模式对妊娠高血压疾病患者身心状态的影响[J].蚌埠医学院学报,2016,41(1):109-112.
[19]孙建华,李云英,彭素清,等.基于Roy适应模式的中医护理方案在突发性耳聋患者中的运用效果分析[J].中医药导报,2016,31(12):110-112.
[20]季丽军. Roy适应模式对乳腺癌改良根治术后患者耻辱感及生存质量的影响[J].中华现代护理杂志,2017,23(17):2296-2298.
[21]陈荣,王建春,傅强.基于Roy模式的中医综合干预方案在结肠癌术后患者中的运用效果[J].中国医药导报,2016,13(16):82-85.
[22]龙艳波,章红,王晓利.基于Roy适应模式的支持护理方案在感音神经性耳聋患者中的应用效果[J].中国当代医药,2016,23(16):182-185.
[23]周燕,黄洁微.Roy适应模式在糖尿病足患者睡眠障碍护理中的应用[J].护士进修杂志,2016,31(4):328-331.