| ObjectiveIn this study,external diaphragm pacemaker was used as exercise equipment to study the application of early external diaphragm pacemaker combined with limb exercise in the prevention of acquired weakness of ICU.To observe the effect of this method on the incidence of ICU acquired weakness,diaphragm function,respiratory function and motor ability in patients with severe mechanical ventilation,in order to reduce the incidence of ICU acquired weakness in patients with severe mechanical ventilation,improve their clinical nursing outcome,and provide reference for early rehabilitation and prevention of ICU acquired weakness in patients with ICU mechanical ventilation.MethodsThis study is experimental.70 ICU patients with mechanical ventilation who met the inclusion and exclusion criteria from November 2020 to October 2021 in a third-class hospital in Henan Province were selected by convenience sampling.Patients were randomly divided into control group and intervention group by random number table method.Patients in both groups received routine nursing and early limb movement rehabilitation during hospitalization with ICU.Patients in the intervention group were given external diaphragm pacing electrical stimulation on the basis of the control group.The incidence of acquired weakness of ICU,related biochemical indexes,diaphragm function and exercise ability were measured on the 1st（pre-intervention measurement）,3rd and 5th day after admission.Among them,the incidence of acquired weakness of ICU on the 5th day was the main outcome index,and the rest was the secondary outcome index.In this study,IBMSPSSStatistics21.0 software was used to input and analyze the collected data.Statistical methods were used to compare the differences among the indexes by statistical description,two independent samples t-test,nonparametric test,chi-square test,generalized estimation equation and so on.Results1.The general data of the two groups were compared before intervention,and there was no significant difference in the general demographic data between the intervention group and the control group（>0.05）.There was no significant difference in clinical characteristics（>0.05）.The baseline data of the two groups were comparable.No significant difference in the number of sedatives and insulin between the two groups during the study period（>0.05）,and there was no significant difference in the total duration of mechanical ventilation between the two groups（>0.05）.The results showed that the mixed factors of the two groups were well controlled and comparable during the whole study period.2.The incidence of acquired weakness of ICU in the intervention group was significantly lower than that in the control group（6.67%Vs 25.81%）on the 3rd day after intervention.At the end of the intervention,the patients in the intervention group were still significantly lower than those in the control group（16.67%Vs 41.94%）,and the difference was statistically significant（<0.05）.3.The comparison of MRC scores between the two groups showed that there was no significant difference in MRC scores between the two groups on the 3rd day of intervention（>0.05）.At the end of the intervention group,the intervention group was significantly higher than the control group（50 scores Vs 48scores）,the difference was statistically significant（<0.05）.There was a significant interaction between time and group in MRC score of the control group.Wald interaction=8.167（<0.05）,that is,MRC score of the control group decreased significantly at the end of the study compared with that before the intervention.But there was no significant change in the intervention group（>0.05）.4.The comparison of grip strength between the two groups showed that there was no significant difference in grip strength between the two groups during the whole study period（>0.05）,and there was no significant change in grip strength between the two groups（>0.05）.5.The comparison of cross-sectional area of rectus femoris between the two groups showed that there was no significant difference in cross-sectional area of rectus femoris between the two groups during the whole study period（>0.05）.The results of intra-group comparison showed that the cross-sectional area of rectus femoris has significant time effect,Wald time=29.300（<0.05）.On the 3rd day of intervention,the patients in the control group had a significant decrease compared with the baseline level（<0.05）,but there was no significant change in the intervention group（>0.05）.On the fifth day of intervention,there was a significant decrease in both groups（<0.05）.The atrophy rate of rectus femoris cross-sectional area was 28.87%in the control group and 9.74%in the intervention group.6.The comparison of diaphragm function indexes between the two groups showed that at the end of the study,diaphragm displacement（13.90 mm Vs 9.40 mm）,end-inspiratory diaphragm thickness（1.40mm Vs 1.10 mm）and diaphragm thickness score（57.61%Vs 42.06%）in the intervention group were significantly higher than those in the control group（<0.05）.There was no significant difference in end-expiratory diaphragm thickness between the two groups（>0.05）.7.The results of blood gas analysis between the two groups showed that the arterial partial pressure of oxygen（91.84 mm Hg Vs 78.87 mm Hg）and potassium concentration（4.01 mmol/L Vs 3.64 mmol/L）in the intervention group were significantly higher than those in the control group at the end of the study（<0.05）.There was no significant difference in sodium ion concentration,blood PH value and arterial carbon dioxide partial pressure between the two groups（>0.05）.ConclusionsExternal diaphragm pacing combined with limb exercise can significantly reduce the incidence of acquired weakness of ICU in patients with severe mechanical ventilation,preserve the strength of upper limb muscles,delay the atrophy rate of rectus femoris,improve diaphragm function and improve breathing.This measure can be used as a new idea to prevent acquired weakness of ICU in patients with severe mechanical ventilation. |
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