摘要
目的 探讨低强度的吸气肌训练对机械通气患者的作用.方法 选取2020年3月至2022年6月南部战区总医院重症监护病房及高依赖病房收治的81例机械通气患者,分为对照组(41例)和试验组(40例).试验过程中对照组失访6例,试验组失访4例,最终两组分别纳入35例和36例患者.对照组采用常规治疗,试验组在常规治疗基础上加用20％最大吸气压(MIP)作为起始阈值负荷的吸气肌训练.训练8周后,评估所有患者的MIP、用力肺活量变化、膈肌厚度、膈肌移动度、再插管率、院内病死率以及生活质量.结果 训练8周后,试验组患者MIP[(29.6± 4.8)cmH2O vs.(20.3±5.5)cmH2O,t=6.402,P＜0.001]、用力肺活量[(1 768±655)mL vs.(1 420± 420)mL,t=4.303,P＜0.001]、膈肌移动度[(0.93±0.44)cm vs.(0.79±0.32)cm,t=2.313,P=0.023]和改良Barthel指数[15(5,19)vs.10(2,14),U=325.500,P=0.040]均较对照组显著改善;而试验组与对照组患者膈肌厚度[(1.47±0.38)mm vs.(1.39±0.45)mm,t=1.195,P=0.236]、再插管率[8.3％(3/36)vs.11.4％(4/35),P=0.520]和院内病死率[8.3％(3/36)vs.5.7％(2/35),P=0.674]比较,差异均无统计学意义.结论 低强度吸气肌训练可以显著提高机械通气患者的MIP及用力肺活量,并可能改善患者的膈肌移动度及生活质量.
Abstract
Objective To explore the effect of low-intensity inspiratory muscle training on mechanically ventilated patients.Methods Eighty-one mechanically ventilated patients admitted to the intensive care unit and high dependency unit of the General Hospital of Southern Theatre Command from March 2020 to June 2022 were selected and randomly divided into a control group(41 patients)and an experimental group(40 patients).Six patients were lost to follow-up in the control group and four patients were lost in the experimental group during the trial,and finally 35 patients and 36 patients were included in the two groups,respectively.The control group was treated with conventional therapy,and the experimental group added inspiratory muscle training with 20％maximal inspiratory pressure(MIP)as the starting threshold load to the conventional therapy.After eight weeks of training,patients were assessed for the MIP,change in exertion spirometry,diaphragm thickness,diaphragm mobility,reintubation rate,in-hospital mortality,and quality of life.Results After eight weeks of training,the MIP[(29.6± 4.8)cmH2O vs.(20.3±5.5)cmH2O,t=6.402,P＜0.001],exertional lung volume[(1 768±655)mL vs.(1 420±420)mL,t=4.303,P＜0.001],diaphragm mobility[(0.93±0.44)cm vs.(0.79±0.32)cm,t=2.313,P=0.023],and modified Barthel index[15(5,19)vs.10(2,14),U-325.500,P=0.040]of patients in the experimental group were significantly improved compared with the control group.The diaphragm thickness[(1.47±0.38)mm vs.(1.39±0.45)mm,t=1.195,P=0.236],reintubation rate[8.3％(3/36)vs.11.4％(4/35),P=0.520],and in-hospital mortality[8.3％(3/36)vs.5.7％(2/35),P=0.674]were not statistically significantly different between the experimental and control groups.Conclusion Low-intensity inspiratory muscle training can significantly improve MIP and exertion spirometry,and may improve diaphragm mobility and quality of life in mechanically ventilated patients.
NETL
NSTL
维普
万方数据