| Objective:To explore the safety and effectiveness of early mobility on respiratory and limb function in patients with mechanical ventilation.Methods:This study was a non-synchronized,non-randomized trial.According to the time order of admission,33 patients with mechanical ventilation who were admitted to the intensive care unit of a third-grade hospital in Lanzhou,that admitted from June,2018to February,2019 were included in the intervention group and 33 cases admitted from March to November,2019 were set as control group.Both groups of patients were given routine care of the intensive care unit of the third-grade hospital,the mobility plan was implemented from the day of enrollment,the control group were given routine care,and the intervention group were given routine care add early mobilization,which include:?1?When the patients were unconscious or poor conscious,he or she would perform turn over on the bed or limbs passive movements;?2?When the patients were conscious and understand the instructions,they would add limbs active mobility,if they could independently complete the limbs active activities,would assist them to sit on the bed;?3?If the patients were conscious and the upper limbs could resist the resistance,would assist them to sit on the edge of the bed;?4?If the patients were conscious and the lower limbs could resist the resistance,would assist the patients to leave the bed and sit on the chairs beside the bed,meanwhile,train standing and walking out of bed on this basis.Analyze and compare the outcomes of two groups:?1?basic information;?2?MRC scores;?3?incidence of ICU acquired weakness;?4?maximum inspiratory pressure?MIP?;?5?respiratory mechanics indicators:lung dynamic compliance,tidal volume and airway resistance;?6?blood gas analysis:PH,PaO2,PaCO2 and HCO3-;?7?duration of mechanical ventilation,ICU hospitalization and total hospitalization time;?8?incidence of adverse events and changes in vital signs before and after the intervention.Statistical analysis was performed using SPSS 21.0 software.Counting data were described by frequency and percentage,and Chi-square test were used for comparison between groups;metering data were described by mean standard deviation?x?S?or median and quartile,comparison between groups were performed by t test or rank sum test.All statistical tests were considered statistically significant by performing P<0.05?two-sided test?.Results:1.A total of 73 patients were included in this study?38 in the intervention group and 35 in the control group?.Among the intervention group,two cases were excluded due to cardiopulmonary resuscitation during tracheal intubation,two cases were excluded due to disease exacerbate and cannot continue to participate in research,one case was excluded due to incomplete data collection;in the control group,one case was excluded due to disease exacerbate cannot continue to participate in research and1 case was excluded due to incomplete data collection.Therefore,this study finally included 66 patients,thirty-three patients in the intervention group and control group respectively.Comparison of baseline data between the two groups was not statistically significant?both P>0.05?and was comparable.2.The MRC scores of the intervention group and the control group were statistically significant at the time of extubation?P=0.005?and at the time of ICU discharge?P<0.001?,and the incidence of ICU-AW were both statistically different at the time of extubation?P=0.003?and at the time of ICU discharge?P<0.001?.3.There was a statistical difference in MIP values between the intervention group and the control group before extubation?P<0.001?.The comparison of MIP values at different time points in the group showed that the MIP value before the extubation in the intervention group?-35.42±7.591?was higher than the time of enrollment?-26.09±6.346?,and the difference of the comparison showed a statistical difference?P<0.001?.The MIP value?-28.73±4.843?of the control group before extubation was higher than that of the other group?-23.58±4.345?,and the difference is statistically significant?P<0.001?,which indicate that early mobility can improve the MIP.4.There was a statistical difference in lung dynamic compliance between the intervention group and the control group?P=0.014?,and no statistical difference in tidal volume?P=0.153?and airway resistance?P=0.097?.Comparison of respiratory mechanics indicators at different time points showed that dynamic compliance of the intervention group?63.300±26.551?before extubation were higher than enrolment?49.420±26.107?,and the difference was statistically significant?P=0.008?,the airway resistance of the intervention group at the time of extubation?7.860±2.315?was lower than that at the time of enrolment?10.070±3.245?,and the difference was statistically significant?P=0.002?,there was no statistical difference in other comparisons.5.The blood gas analysis indicators of the intervention group and the control group showed that there were statistical differences in HCO3-?P<0.001?,and there was no statistical difference in PaO2?P=0.262?,PH?P=0.078?and PaCO2?P=0.781?.6.The duration of ICU hospitalization,total hospitalization and mechanical ventilation in the intervention group were all shorter than those in the control group?10.910±5.660 vs 20.610±11.270,17.090±9.530 vs 24.120±9.310,7.900±4.720 vs14.900±6.820?,and the differences had statistical difference?P<0.05?.7.Adverse events occurred 4 cases in the intervention group?two cases of too fast breathing and two cases of arrhythmia?,and two cases in the control group?two cases of too fast breathing?,and the difference had no statistical difference?P=0.392?.There were no statistical difference of the vital signs between the intervention group and the control group.Conclusion:Early mobility can improve respiratory muscle strength and lung dynamic compliance in patients with mechanical ventilation,reduce airway resistance,and improve respiratory function in patients;Early mobility can improve the limb muscle strength of patients with mechanical ventilation,improve the physical function,and reduce the incidence of ICU acquired weakness;Early mobility are relatively safe and feasible of the patients that strictly select from that meet the safety standards of early activities. |
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