早期目标导向活动在机械通气脱机困难患者中的应用

doi:10.3761/j.issn.2096-7446.2025.11.005

摘要/Abstract

摘要：

目的探讨基于约翰霍普金斯最高水平活动量表的早期目标导向活动在ICU机械通气脱机困难患者中的应用效果。方法选取广州市某三级甲等医院ICU收治的脱机困难患者为研究对象，2023年7月—2024年12月收治的患者为试验组，实施以霍普金斯最高水平活动量表为目标导向的早期活动；2022年1月—2023年6月收治的患者为对照组，实施常规康复训练。比较两组患者的ICU获得性衰弱发生率、ICU住院时间、机械通气时间、撤机成功率等。结果共96例患者完成研究，两组各48例。试验组ICU获得性衰弱发生率、撤机成功率均高于对照组，差异具有统计学意义（P<0.05），试验组ICU住院时间、机械通气时间均低于对照组，差异具有统计学意义（P<0.05）。结论基于约翰霍普金斯最高水平活动量表的早期目标导向活动能有效降低机械通气脱机困难患者ICU获得性衰弱的发生率，缩短ICU住院时间及机械通气时间，提高撤机成功率，加快患者康复。

关键词: 约翰霍普金斯最高水平活动量表, 机械通气, 脱机困难, 康复护理

Abstract:

Objective To investigate the effects of the goal-oriented mobilization based on the Johns Hopkins Highest Level of Mobility in ICU patients with difficult weaning from mechanical ventilation. Methods Patients with weaning difficulties from ICU of a tertiary class A hospital in Guangzhou City from July 2023 to December 2024 were selected as the experimental group，and early mobilization based on the Johns Hopkins Highest Level of Mobility was implemented. Patients with weaning difficulties admitted from January 2022 to June 2023 were selected as control group，and routine rehabilitation training was carried out. The incidence of ICU acquired weakness，length of stay in ICU，duration of mechanical ventilation and success rate of weaning were compared between the two groups. Results 96 patients completed the study，including 48 in the control group and 48 in the experimental group. The incidence rate of ICU acquired weakness and weaning success rate of the experimental group were higher than those in the control group，and the differences were statistically significant（P<0.05）. The length of stay in ICU and mechanical ventilation time of the experimental group were lower and the differences were statistically significant（P<0.05）. Conclusion Goal-oriented early mobilization based on the Johns Hopkins Highest Level of Mobility can effectively reduce the incidence of ICU acquired weakness，shorten ICU stay and mechanical ventilation duration，improve weaning success rate，and accelerate patient recovery.

Key words: Johns Hopkins Highest Level of Mobility, Mechanical Ventilation, Difficult Weaning, Rehabili-tation Nursing

何志丽, 卫政登, 王巧金, 白利平, 高明榕. 早期目标导向活动在机械通气脱机困难患者中的应用[J]. 中华急危重症护理杂志, 2025, 6(11): 1310-1315.

HE Zhili, WEI Zhengdeng, WANG Qiaojin, BAI Liping, GAO Mingrong. Application of goal-directed early mobilization in patients with difficult weaning from mechanical ventilation[J]. Chinese Journal of Emergency and Critical Care Nursing, 2025, 6(11): 1310-1315.

图/表 3

参考文献 29

[1]	Tanaka A, Shimomura Y, Uchiyama A, et al. Time definition of reintubation most relevant to patient outcomes in critically ill patients:a multicenter cohort study[J]. Crit Care, 2023, 27(1):378. doi: 10.1186/s13054-023-04668-3
[2]	Virolle S, Duceau B, Morawiec E, et al. Contribution and evolution of respiratory muscles function in weaning outcome of ventilator-dependent patients[J]. Crit Care, 2024, 28(1):421. doi: 10.1186/s13054-024-05172-y
[3]	Nicolotti D, Grossi S, Nicolini F, et al. Difficult respiratory weaning after cardiac surgery:a narrative review[J]. J Clin Med, 2023, 12(2):497. doi: 10.3390/jcm12020497
[4]	Singam A. Mobilizing progress:a comprehensive review of the efficacy of early mobilization therapy in the intensive care unit[J]. Cureus, 2024, 16(4):e57595.
[5]	计可欣, 程洁, 郑卿勇, 等. ICU患者早期活动方案的研究进展[J]. 中国康复医学杂志, 2023, 38(12):1784-1791.
	Ji KX, Cheng J, Zheng QY, et al. Research progress of early activity program for ICU patients[J]. Chin J Rehabil Med, 2023, 38(12):1784-1791.
[6]	张婉竹, 米洁. ICU病人早期活动安全性评估工具的研究进展[J]. 护理研究, 2024, 38(14):2549-2553.
	Zhang WZ, Mi J. Research progress on safety assessment tool in early activity for ICU patients[J]. Chin Nurs Res, 2024, 38(14):2549-2553.
[7]	Hiser S, Chung CR, Toonstra A, et al. Inter-rater reliability of the Johns Hopkins Highest Level of Mobility Scale(JH-HLM) in the intensive care unit[J]. Braz J Phys Ther, 2021, 25(3):352-355. doi: 10.1016/j.bjpt.2020.07.010
[8]	Fuchita M, Ridgeway KJ, Sandridge B, et al. Comparison of postoperative mobilization measurements by activPAL versus Johns Hopkins Highest Level of Mobility scale after major abdominal surgery[J]. Surgery, 2023, 174(4):851-857. doi: 10.1016/j.surg.2023.07.014
[9]	Bureau C, Demoule A. Weaning from mechanical ventilation in neurocritical care[J]. Rev Neurol, 2022, 178(1/2):111-120. doi: 10.1016/j.neurol.2021.08.005
[10]	俞玲娜. 早期主动干预改善ICU获得性衰弱的研究[D]. 大连: 大连医科大学, 2013.
	Yu LN. Study on early active intervention to improve ICU acquired weakness[D]. Dalian: Dalian Medical University, 2013.
[11]	Hoyer EH, Young DL, Klein LM, et al. Toward a common language for measuring patient mobility in the hospital:reliability and construct validity of interprofessional mobility measures[J]. Phys Ther, 2018, 98(2):133-142. doi: 10.1093/ptj/pzx110 pmid: 29106679
[12]	Sousa VD, Rojjanasrirat W. Translation,adaptation and validation of instruments or scales for use in cross-cultural health care research:a clear and user-friendly guideline[J]. J Eval Clin Pract, 2011, 17(2):268-274. doi: 10.1111/jep.2011.17.issue-2
[13]	Aquim EE, Bernardo WM, Buzzini RF, et al. Brazilian guidelines for early mobilization in intensive care unit[J]. Rev Bras Ter Intensiva, 2019, 31(4):434-443.
[14]	Girard TD, Alhazzani W, Kress JP, et al. An official American thoracic society/American college of chest physicians clinical practice guideline:liberation from mechanical ventilation in critically ill adults. rehabilitation protocols,ventilator liberation protocols,and cuff leak tests[J]. Am J Respir Crit Care Med, 2017, 195(1):120-133. doi: 10.1164/rccm.201610-2075ST
[15]	Lang JK, Paykel MS, Haines KJ, et al. Clinical practice guidelines for early mobilization in the ICU:a systematic review[J]. Crit Care Med, 2020, 48(11):e1121-e1128.
[16]	倪莹莹, 王首红, 宋为群, 等. 神经重症康复中国专家共识(上)[J]. 中国康复医学杂志, 2018, 33(1):7-14.
	Ni YY, Wang SH, Song WQ, et al. Chinese expert consensus on neurocritical care rehabilitation(part 1)[J]. Chin J Rehabil Med, 2018, 33(1):7-14.
[17]	王秋雁, 边仁秀, 戎军, 等. 浙江省重症康复专家共识[J]. 浙江医学, 2017, 39(24):2191-2196,2209.
	Wang QY, Bian RX, Rong J, et al. Zhejiang provincial consensus on critical care rehabilitation[J]. Zhejiang Med J, 2017, 39(24):2191-2196,2209.
[18]	Wang LJ, Hua YS, Wang LP, et al. The effects of early mobilization in mechanically ventilated adult ICU patients:systematic review and meta-analysis[J]. Front Med, 2023,10:1202754.
[19]	Zhang L, Hu WS, Cai ZY, et al. Early mobilization of critically ill patients in the intensive care unit:a systematic review and meta-analysis[J]. PLoS One, 2019, 14(10):e0223185. doi: 10.1371/journal.pone.0223185
[20]	Hodgson CL, Stiller K, Needham DM, et al. Expert consensus and recommendations on safety criteria for active mobilization of mechanically ventilated critically ill adults[J]. Crit Care, 2014, 18(6):658. doi: 10.1186/s13054-014-0658-y
[21]	姚晖, 段晓磊, 高雯晴, 等. 早期目标导向活动方案对胰腺肿瘤切除术后患者活动的影响[J]. 中国护理管理, 2024, 24(5):713-718.
	Yao H, Duan XL, Gao WQ, et al. Effects of early goal-directed mobilization protocols on the activity of patients after pancreatic tumor resection[J]. Chin Nurs Manag, 2024, 24(5):713-718.
[22]	Xavier B, Vaithilingan S, Avudaiappan S, et al. The impact of an early mobility protocol on recovery outcomes in patients undergoing abdominal surgeries[J]. Cureus, 2024, 16(12):e75980.
[23]	卞红, 俞萍. 早期目标导向活动方案对ICU机械通气病人获得性衰弱的影响[J]. 护理研究, 2021, 35(7):1248-1251.
	Bian H, Yu P. Effect of goal-oriented early mobilisation program on acquired weakness of mechanically ventilated patients in ICU[J]. Chin Nurs Res, 2021, 35(7):1248-1251.
[24]	Lin YJ, Liang T, Zhang X, et al. Early goal-directed mobilization in patients with acute type A aortic dissection:a randomized controlled trial[J]. Clin Rehabil, 2023, 37(10):1311-1321. doi: 10.1177/02692155231169822
[25]	Shah NM, Hart N, Kaltsakas G. Prolonged weaning from mechanical ventilation:who,what,when and how?[J]. Breathe, 2024, 20(3):240122. doi: 10.1183/20734735.0122-2024
[26]	Li FY, Goh KS, Yu X, et al. Mobility matters:a protocol to improve mobility and reduce length of stay in hospitalised older adults[J]. BMJ Open Qual, 2025, 14(1):e003084. doi: 10.1136/bmjoq-2024-003084
[27]	Pal C, Fu C, et al. Mobility levels of critically ill adult patients and extubation success[J]. Respir Care, 2025, 70(4):393-399.
[28]	Dadam MM, Pereira AB, Cardoso MR, et al. Effect of reintu-bation within 48 hours on mortality in critically ill patients after planned extubation[J]. Respir Care, 2024, 69(7):829-838. doi: 10.4187/respcare.11077
[29]	朱蔚仪, 周玉华, 赵仲和, 等. 电疗联合早期活动在慢性阻塞性肺疾病撤机困难病人中的应用[J]. 护理研究, 2017, 31(29):3750-3752.
	Zhu WY, Zhou YH, Zhao ZH, et al. Application of electrotherapy combined with early activities in patients with chronic obstructive pulmonary disease[J]. Nurs Res China, 2017, 31(29):3750-3752.