张超 王贵玲 王青青 陈玉柱 张鑫

【摘要】 目的：探究ICU內接受机械通气的昏迷患者行早期肢体被动运动的效果和临床意义评价。方法：选取2018年8月-2020年8月本院诊治的136例ICU内接受机械通气的昏迷患者作为研究对象，按照随机数字表法将其分为研究组和对照组，各68例。对照组给予ICU肢体运动及护理，研究组在对照组基础上给予早期肢体被动运动。对比两组呼吸指标变化、循环指标变化、肌肉力量恢复、机械通气时间、ICU治疗时间和并发症发生情况。结果：研究组护理后脉氧饱和度明显高于对照组与护理前（P<0.05）。研究组护理后心率明显低于对照组与护理前，平均动脉压明显高于对照组与护理前（P<0.05）。两组护理后MRC评分较护理前均明显提高，且研究组高于对照组（P<0.05）。研究组谵妄、DTV和ICU获得性衰弱的发生率均明显低于对照组（P<0.05）。结论：ICU内接受机械通气的昏迷患者行早期肢体被动运动能有效促进呼吸功能和循环功能的康复，促进肌肉力量的恢复，缩短机械通气时间和ICU治疗时间，降低谵妄、DTV和获得性衰弱等并发症发生率，改善患者预后。

【关键词】 机械通气 昏迷 早期肢体被动运动 谵妄 ICU获得性衰弱

Evaluation of Effect and Clinical Significance of Early Passive Limb Exercises in Comatose Patients Receiving Mechanical Ventilation in ICU/ZHANG Chao， WANG Guiling， WANG Qingqing， CHEN Yuzhu， ZHANG Xin. //Medical Innovation of China， 2021， 18（33）： -177

[Abstract] Objective： To explore the effect and clinical significance of early passive limb exercises in comatose patients receiving mechanical ventilation in ICU. Method： A total of 136 patients with mechanical ventilation in ICU who diagnosed and treated in our hospital from August 2018 to August 2020 were selected as the research objects， they were randomly divided into the study group （n=68） and the control group （n=68） according to the random number table method. The control group was given ICU limb movement and nursing， the study group was given early passive limb exercises on the basis of the control group. The respiratory indicators， circulatory indicators， muscle strength recovery， mechanical ventilation time， ICU treatment time， and occurrence of complications between two groups were compared. Result： The pulse oxygen saturation in the study group after nursing was significantly higher than those in the control group and before nursing （P<0.05）. The heart rate of the study group after nursing was significantly lower than those of the control group and before nursing， and the average arterial pressure was significantly higher than those of the control group and before nursing （P<0.05）. The MRC scores of two groups after nursing were significantly higher than those before nursing， and the study group was higher than that of the control group （P<0.05）. The incidence of delirium， DTV and ICU acquired weakness in the study group were significantly lower than those in the control group （P<0.05）. Conclusion： Early passive limb exercises in comatose patients receiving mechanical ventilation in ICU can effectively promote the recovery of respiratory and circulatory functions， and accelerate the recovery of muscle strength， shorten the time of mechanical ventilation and ICU treatment， reduce the occurrence of complications such as delirium， DTV and ICU acquired weakness， and improve the prognosis of patients.

[Key words] Mechanical ventilation Comatose Early passive limb exercises Delirium ICU acquired weakness

First-author’s address： Hongze District People’s Hospital， Huai’an 223100， China

doi：10.3969/j.issn.1674-4985.2021.33.042

昏迷是重症监护病房（intensivecare unit，ICU）中患者常见的一种临床表现，其主要表现为意识模糊或障碍，呼之不应，甚至对外界刺激无反应等。ICU针对病情较重患者常采用机械通气的方式，可有效降低ICU死亡率[1]。但是ICU内接受机械通气的昏迷患者因长期处于卧床状态，且使用较多镇静剂，导致其肌肉、骨骼、循环、内分泌和呼吸等系统功能出现下降或紊乱等，严重影响患者生存质量。……