舒适化浅镇静联合分级化早期活动对重症监护室老年机械通气患者获得性衰弱的干预效果分析

Analysis of the intervention effects of comfortable minimal sedation combined with graded early activity on intensive care unit-acquired weakness in elderly patients undergoing mechanical ventilation

中文关键词: 老年, 舒适化浅镇静, 机械通气, 重症监护室获得性衰弱

英文关键词: elderly  comfortable minimal sedation  mechanical ventilation  intensive care unit-acquired weakness

中文摘要:

      目的 探讨舒适化浅镇静(eCASH)联合分级化早期活动对接受机械通气治疗的老年患者重症监护室获得性衰弱(ICU-AW)的治疗效果.方法 选取2022年1月-2022年12月于复旦大学附属闵行医院重症监护室(ICU)就诊并接受机械通气治疗的168例患者,随机分为观察组(n=84)和对照组(n=84).对照组采取ICU常规康复镇静方案,观察组采取eCASH联合分级化早期活动.比较2组入ICU后第1、3、5、7天的Richmond躁动-镇静量表(RASS)、医学研究理事会肌肉力量(MRC)和日常生活活动能力(ADL)评分;对比2组的镇静药使用量、机械通气时间和ICU停留时间.结果 与对照组相比,观察组异丙酚用量较少,机械通气和ICU停留时间较短,差异有统计学意义(P＜0.05).2组MRC(F=36.087,P＜0.01)和ADL(F=14.201,P＜0.01)评分的时间与分组均存在交互作用.与进入ICU后第1天相比,2组进入ICU后第3、5、7天的MRC和ADL评分升高,差异均有统计学意义(P＜0.001).与进入ICU后第1天相比,2组进入ICU后第7天ICU-AW构成比差异有统计学意义(26.19％vs 65.29％,P=0.013).结论 老年ICU患者eCASH联合分级化早期活动可能有助于降低ICU-AW发生率,改善患者预后.

英文摘要:

      Objective To explore the therapeutic effects of comfortable minimal sedation combined with graded early ac-tivity on intensive care unit-acquired weakness(ICU-AW)in elderly patients undergoing mechanical ventilation.Methods 168 patients who were admitted to intensive care unit(ICU)of Minhang Hospital Affiliated to Fudan University and received me-chanical ventilation therapy from January 2022 to December 2022 were randomly divided into observation group(n=84)and control group(n=84).The control group received routine rehabilitation sedation plan in ICU,and the observation group re-ceived comfortable minimal sedation combined with graded early activity.The scores of Richmond Agitation-Sedation Scale(RASS),Medical Research Council Muscle Strength(MRC)and Activities of Daily Living(ADL)were compared between the two groups at 1,3,5 and 7 days after admission to ICU.The dosage of sedative drugs,duration of mechanical ventilation and ICU stay time were compared between the two groups.Results Compared with the control group,the observation group used significantly less propofol and had shorter duration of mechanical ventilation and ICU stay time,with statistically signifi-cant differences(P＜0.05).There was an interaction between the time distribution and grouping of the scores of MRC(F=36.087,P＜0.01)and ADL(F=14.201,P＜0.01)in both groups.Compared with the first day after admission to ICU,the scores of MRC and ADL of the two groups at day 3,5 and 7 after admission to ICU increased,with statistical significance(P＜0.001).On day 7 after admission to ICU,there was a statistically significant difference in the composition ratio of ICU-AW patients between the two groups(26.19％vs 65.29％,P=0.013).Conclusion The combination of comfortable mini-mal sedation and graded early activity may help reduce the incidence of ICU-AW in elderly ICU patients and improve their prognosis.