下肢运动方式对COPD有创机械通气患者肌力的影响

doi:10.13438/j.cnki.jdzk.2020.05.014

吉首大学学报（自然科学版） ›› 2020, Vol. 41 ›› Issue (5): 70-76.DOI: 10.13438/j.cnki.jdzk.2020.05.014

下肢运动方式对COPD有创机械通气患者肌力的影响

陈姗，李玉翠，赵成岗，陈思宇，邓丽林，周丽丽，成沛玉

(1.南华大学护理学院，湖南衡阳 421000；2.湘潭市第一人民医院，湖南湘潭 411100)

出版日期:2020-09-25 发布日期:2021-02-04
通讯作者: 成沛玉（1967—），女，湖南湘潭人，湘潭市第一人民医院主任护师，硕士生导师，主要从事危重症护理、护理管理研究.E-mail：517761145@qq.com.
作者简介:陈姗（1995—），女，浙江绍兴人，南华大学护理学院护师，硕士研究生，主要从事急危重症护理研究
基金资助:
湘潭市科技局项目（ZDX-SF2019019）

Influence of Lower Limb Movement on Muscle Strength in COPD Patients with Invasive Mechanical Ventilation

CHEN Shan, LI Yucui, ZHAO Chenggang, CHEN Siyu, DENG Lilin, ZHOU Lili, CHENG Peiyu

(1. School of Nursing, University of South China, Hengyang, 421000, Hunan China；2. The First People's Hospital of Xiangtan City, Xiangtan 411100, Hunan China)

Online:2020-09-25 Published:2021-02-04

摘要/Abstract

摘要：为了比较运动方式对COPD有创机械通气患者肌力的影响，对入住ICU的112例COPD有创机械通气患者进行分组对照实验.按预设的早期运动方案，两组患者下肢运动方式不一样，干预组采用床上脚踏车进行下肢运动，对照组采用手动下肢运动.结果表明，脱离ICU监护时下肢主、客观肌力指标、ICU活动水平和Barthel指数评分以及出院时Barthel指数评分，两组患者之间差异有统计学意义(P<0.05)，脱离ICU监护时上肢主、客观肌力指标和出院6个月Barthel指数，两组患者之间差异无统计学意义(P>0.05)，说明COPD有创机械通气患者实施床上脚踏车运动安全可行，且可以改善下肢肌力和运动水平，促进日常生活功能的恢复.

关键词： 慢性阻塞性肺疾病, 机械通气, 早期运动, 肌力

Abstract: To compare the influences of exercise mode on COPD patietns with invasive mechanical ventilation, 112 COPD patients who stayed in ICU conducted a group controlled experiment. According to the predetermined proposals, two groups of patients took different lower limb movement. The intervention group performed in-bed bicycle exercise, while the control group performed traditional in-bed exercise. The results indicated that there were significant differences subjective and objective indicators of lower limb, level of activation in ICU when patients left ICU as well as Barthel index scores when patients left ICU and discharged from hospital respectively between two groups (P<0.05). There were no significant differences in upper limb muscle strength measured either by electronic grip gauge or MRC scale between two groups (P>0.05). There was no significant difference in Barthel index score measured in the first six months after discharge (P>0.05). The results show that early in-bed bicycle exercise is secure and workable for COPD patietns with invasive mechanical ventilation, which can improve lower limb muscle strength and mobility and promote recovery of activities of daily living.

Key words: Chronic Obstructive Pulmonary Disease, Mechanical Ventilation, Early Mobilization, Muscle Strength

陈姗, 李玉翠, 赵成岗, 陈思宇, 邓丽林, 周丽丽, 成沛玉. 下肢运动方式对COPD有创机械通气患者肌力的影响[J]. 吉首大学学报（自然科学版）, 2020, 41(5): 70-76.

CHEN Shan, LI Yucui, ZHAO Chenggang, CHEN Siyu, DENG Lilin, ZHOU Lili, CHENG Peiyu. Influence of Lower Limb Movement on Muscle Strength in COPD Patients with Invasive Mechanical Ventilation[J]. Journal of Jishou University(Natural Sciences Edition), 2020, 41(5): 70-76.

参考文献

[1] SCHMIDT M, DEMOULE A, DESLANDES-BOUTMY E, et al. Intensive Care Unit Admission in Chronic Obstructive Pulmonary Disease: Patient Information and the Physician's Decision-Making Process[J]. Critical Care, 2014, 18(3): R115-R123.
[2] SORIANO J B, KENDRICK P J, PAULSON K R, et al. Prevalence and Attributable Health Burden of Chronic Respiratory Diseases, 1990-2017: A Systematic Analysis for the Global Burden of Disease Study 2017[J]. The Lancet Respiratory Medicine, 2020, 8(6): 585-596.
[3] FAN E. Critical Illness Neuromyopathy and the Role of Physical Therapy and Rehabilitation in Critically Ill Patients[J]. Respiratory Care, 2012, 57(6): 933-944.
[4] HODGSON C L, CAPELL E, TIPPING C J. Early Mobilization of Patients in Intensive Care: Organization, Communication and Safety Factors that Influence Translation into Clinical Practice[J]. Critical Care, 2018, 22(1): 77-83.
[5] NYDAHL P, RUHL A P, BARTOSZEK G, et al. Early Mobilization of Mechanically Ventilated Patients: A 1-Day Point-Prevalence Study in Germany[J]. Critical Care Medicine, 2014, 42(5): 1178-1186.
[6] DIRKES S M, KOZLOWSKI C. Early Mobility in the Intensive Care Unit: Evidence, Barriers, and Future Directions[J]. Critical Care Nurse, 2019, 39(3): 33-42.
[7] VOGELMEIER C F, CRINER G J, MARTINEZ F J, et al. Global Strategy for the Diagnosis, Management and Prevention of Chronic Obstructive Lung Disease 2017 Report[J]. American Journal of Respiratory and Critical Care Medicine, 2017, 195(5)：557-582.
[8] 黄海燕,王小芳,罗健,等.ICU机械通气患者早期四级康复训练效果[J].护理学杂志,2016,31(15):1-5.
[9] 蔡柏蔷,陈荣昌.慢性阻塞性肺疾病急性加重(AECOPD)诊治中国专家共识(2017年更新版)[J]. 国际呼吸杂志, 2017,37(14):1041-1057.
[10] 张川林,张泽菊,米洁,等.ICU活动量表的汉化及信效度研究[J].护理学杂志,2019,34(10):46-48.
[11] 王彩虹,秦君玫,贲艳丽.早期康复训练对机械通气患者ICU获得性肌无力的改善效果[J].中国护理管理, 2019,19(3):457-461.
[12] HSUEH I P, LIN J H, JENG J S, et al. Comparison of the Psychometric Characteristics of the Functional Independence Measure, 5 Item Barthel Index, and 10 Item Barthel Indexin Patients with Stroke[J]. Journal of Neurology Neurosurgery & Psychiatry, 2002, 73(2): 188-190.
[13] 窦凤娇.慢性阻塞性肺疾病患者基于手机应用程序辅助式运动训练的效果研究[D].北京：北京协和医学院,2016.
[14] GADRE S K, DUGGAL A, MIRELES-CABODEVILA E, et al. Acute Respiratory Failure Requiring Mechanical Ventilation in Severe Chronic Obstructive Pulmonary Disease (COPD)[J]. Medicine (Baltimore), 2018, 97(17): e487.
[15] MADDOCKS M, NOLAN C M, MAN W D, et al. Neuromuscular Electrical Stimulation to Improve Exercise Capacity in Patients With Severe COPD: A Randomised Double-Blind, Placebo-Controlled Trial[J]. Lancet Respir Medicine, 2016, 4(1): 27-36.
[16] PUTHUCHEARY Z A, HART N. Skeletal Muscle Mass and Mortality—But What About Functional Outcome?[J]. Critical Care, 2014, 18: 110.
[17] GOSSELINK R, BOTT J, JOHNSON M, et al. Physiotherapy for Adult Patients with Critical Illness: Recommendations of the European Respiratory Society and European Society of Intensive Care Medicine Task Force on Physiotherapy for Critically Ill Patients[J]. Intensive Care Medicine, 2008, 34(7): 1188-1199.
[18] PIRES-NETO R C, PEREIRA A L, PARENTE C, et al. Characterization of the Use of a Cycle Ergometer to Assist in the Physical Therapy Treatment of Critically Ill Patients[J]. Rev. Bras. Ter. Intensiva, 2013, 25(1): 39-43.
[19] MEDRINAL C, COMBRET Y, PRIEUR G, et al. Comparison of Exercise Intensity During Four Early Rehabilitation Techniques in Sedated and Ventilated Patients in ICU: A Randomised Cross-Over Trial[J]. Critical Care, 2018, 22: 110-117.
[20] BURTIN C, CLERCKX B, ROBBEETS C, et al. Early Exercise in Critically Ill Patients Enhances Short-Term Functional Recovery[J]. Critical Care Medicine, 2009, 37(9): 2499-2505.

下肢运动方式对COPD有创机械通气患者肌力的影响

Influence of Lower Limb Movement on Muscle Strength in COPD Patients with Invasive Mechanical Ventilation

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