目的 分析早期活动康复对机械通气患儿肌力的影响,探讨影响肌力的相关因素.方法 采取回顾性研究,选择2021年4月—2023年4月医院收治的104例机械通气患儿临床资料,根据康复方法分为两组,其中采取常规康复训练的52例患儿为对照组,采取早期活动康复的52例患儿为观察组.两组均连续干预至出院,比较两组患儿的机械通气、住ICU、总住院时间、不同时点(转出ICU时、出院时、出院1个月)的肌力及Barthel日常生活能力(Barthel)评分;参照《中国重症肌无力诊断和治疗指南(2015年简版)》中诊断标准,评估机械通气患儿获得性肌无力(AW)发生情况.统计并比较两组基线资料,采用二元Logistic回归分析机械通气患儿AW发生的影响因素.结果 观察组的机械通气、住ICU及总住院时间[(7.28±2.47)d、(15.27±3.64)d、(27.08±5.68)d]均短于对照组[(10.64±3.39)d、(17.74±3.55)d、(32.57±6.14)d](P＜0.05);与转出ICU时、出院时相比,两组出院1个月时英国医学研究委员会(MRC)肌力评定法评分升高,且观察组转出ICU时、出院时MRC评分[(53.57±5.13)分、(56.84±2.16)分]均高于对照组[(50.13±4.57)分、(53.67±2.42)分],两组组间·时点交互比较差异有统计学意义(P＜0.05);与转出ICU时、出院时相比,两组出院1个月时Barthel评分升高,且观察组转出ICU时、出院时Barthel评分[(65.03±12.47)分、(90.58±7.59)分]均高于对照组[(55.25±11.12)分、(84.13±9.62)分],两组组间·时点交互比较差异有统计学意义(P＜0.05);住院期间104例机械通气患儿发生AW 31例,发生率29.81%,AW组机械通气时间、营养风险筛查量表2002(NRS)评分[(11.84±4.19)d、(3.07±1.04)分]高于非AW组[(8.18±2.26)d、(1.61±0.75)分],且有创机械通气模式、使用罗库溴铵患儿[77.42%(24/31)、32.26%(10/31)]占比均高于非AW组[53.42%(39/73)、13.70%(10/73)](P＜0.05);二元Logistic回归分析结果显示,机械通气时间长、有创机械通气模式、使用罗库溴铵、NRS评分高是机械通气患儿AW发生的危险因素(OR＞1,P＜0.05).结论 早期活动康复能够有效缩短机械通气患儿患儿通气时间及住院时间,改善肌力,提高生活自理能力,同时机械通气时间、创机械通气模式、使用罗库溴铵、NRS评分与机械通气患儿肌力下降有关.
Objective To analyze the effect of early mobilization and rehabilitation on muscle strength in children with mechanical ventilation and to explore the risk factors affecting muscle strength.Methods A retrospective study was conducted on 104 children with mechanical ventilation admitted to the hospital from April 2021 to April 2023.According to the rehabilitation methods,they were divided into two groups.The clinical data of children with routine rehabilitation training were included in the control group(52 cases),and the clinical data of children with early mobilization and rehabilitation were included in the observation group(52 cases).Both groups were continuously intervened until discharged.The mechanical ventilation time,ICU stay and total hospital stay were compared between the two groups.Muscle strength and self-care ability at different time points(transfer out of ICU,discharge,1 month after discharge),the incidence of acquired weakness(AW)in children with mechanical ventilation were evaluated according to the diagnostic criteria in the Chinese Guidelines for the Diagnosis and Treatment of Myasthenia Gravis.Baseline data was collected and compared between the two groups.Binary logistic regression was used to analyze the risk factors of AW in children with mechanical ventilation.Results The mechanical ventilation time,ICU and total hospitalization time in the observation group[(7.28±2.47)d,(15.27±3.64)d,(27.08±5.68)d]were shorter than those in the control group[(10.64±3.39)d,(17.74±3.55)d,(32.57±6.14)d](P＜0.05).Compared with those at the time of transfer out of ICU and discharge,the Medical Research Council(MRC)scores of the two groups increased at 1 month after discharge,and the MRC scores of the observation group at the time of transfer out of ICU and discharge[(53.57±5.13),(56.84±2.16)]were higher than those of the control group[(50.13±4.57),(53.67±2.42)].There were significant differences between the two groups,time points and between groups·time points(P＜0.05).Compared with those at the time of transferring out of ICU and at discharge,the Barthel scores of the two groups increased at 1 month after discharge,and the Barthel scores of the observation group at the time of transferring out of ICU and at discharge[(65.03±12.47),(90.58±7.59)]were higher than those of the control group[(55.25±11.12),(84.13±9.62)].There were significant differences in Barthel scores between the two groups,time points and groups·time points(P＜0.05).AW occurred in 31 of 104 children with mechanical ventilation during hospitalization,with an incidence of 29.81%.The mechanical ventilation time and Nutritional Risk Screening(NRS)score in the AW group[(11.84±4.19)d,(3.07±1.04)]were higher than those in the non-AW group[(8.18±2.26)d,(1.61±0.75)].The proportion of children with invasive mechanical ventilation mode and the use of rocuronium[77.42%(24/31),32.26%(10/31)]were higher than those in the non-AW group[53.42%(39/73),13.70%(10/73)](P＜0.05).Binary logistic regression analysis showed that long mechanical ventilation time,invasive mechanical ventilation,use of rocuronium and high NRS score were risk factors for AW in children with mechanical ventilation(OR＞1,P＜0.05).Conclusions Early mobilization and rehabilitation can effectively shorten the ventilation time and hospitalization time of patients with mechanical ventilation,improve muscle strength and improve the ability of self-reliance.At the same time,mechanical ventilation time,mechanical ventilation mode,use of rocuronium and NRS score are related to the decrease of muscle strength in children with mechanical ventilation.
吴清坦;蔡棉棉;庄江兰
泉州市妇幼保健院(泉州市儿童医院)重症医学科(福建泉州 362000)
机械通气;肌力;早期活动康复;自理能力
mechanical ventilation;muscle strength;early mobilization and rehabilitation;self-care ability
《广州医药》 2024 (004)
370-376,396 / 8
10.3969/j.issn.1000-8535.2024.04.006
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