机械通气清醒患者早期床边坐起活动方案的最佳证据总结

doi:10.3761/j.issn.2096-7446.2025.11.010

摘要/Abstract

摘要：

目的总结ICU机械通气清醒患者早期床边坐起活动方案的最佳证据，为临床医护人员实施其床边坐起实践提供参考。方法基于PIPOST确定循证问题，制订检索策略，计算机检索国内外专业指南网、协会网及数据库内有关ICU机械通气清醒患者早期床边坐起的所有指南、证据总结、最佳实践信息册、推荐实践、系统评价及原始研究。由循证小组对纳入文献进行质量评价、证据提取和总结。结果最终纳入文献14篇，包括3篇指南、1篇系统评价、1篇证据总结、9篇原始研究，综合为11个维度的证据，分别是组建多学科团队、床边坐起宣教、床边坐起前评估、床边坐起开始时间、床边坐起前准备工作、床边坐起方式、床边坐起频次、呼吸机模式选择、患者安置、床边坐起监测管理、床边坐起终止标准，共25条证据。结论 ICU机械通气清醒患者早期床边坐起具有重要实践意义，医护人员需要根据患者早期床边坐起的异质性进行科学管理，强化早期床边坐起的质量控制，确保患者安全。

关键词: 机械通气, 床边坐起, 康复运动, 早期活动, 证据总结, 循证护理学

Abstract:

Objective To evaluate the relevant evidence of bedside sitting in ICU awake patients with mechanical ventilation，so as to provide a reference for clinical medical staff to implement their practice of bedside sitting. Methods Based on PIPOST，evidence-based questions were identified，search strategies were developed，and all guidelines，evidence summaries，best practice information books，recommended practices，systematic reviews and original studies on bedside sitting of mechanically ventilated awake patients in ICU were searched by computer in professional guide networks，association networks and databases at home and abroad. The quality evaluation，evidence extraction and evidence summary of the included literatures were carried out by the evidence-based team. Results 14 literatures were included，including three guidelines，a systematic review，an evidence summary and nine original studies. 25 pieces of evidence were summarized into 11 dimensions，including the establishment of multidisciplinary team，bedside sitting education，bedside sitting assessment，bedside sitting start time，bedside sitting preparation，bedside sitting mode，bedside sitting frequency，ventilator mode selection，patient placement，bedside sitting monitoring management，and termination standards. Conclusion Bedside sitting in awake patients with mechanical ventilation in ICU has important practical significance. Medical staff should scientifically manage bedside sitting according to the heterogeneity of bedside sitting，strengthen the quality control of bedside sitting，and ensure the safety of patients.

Key words: Mechanical Ventilation, Sitting at the Bedside, Rehabilitation Exercise, Early Activity, Summary of Evidence, Evidence-Based Nursing

姜云龙, 周燕, 胡俊, 高兵兵, 黄昉芳. 机械通气清醒患者早期床边坐起活动方案的最佳证据总结[J]. 中华急危重症护理杂志, 2025, 6(11): 1342-1348.

JIANG Yunlong, ZHOU Yan, Hu Jun, GAO Bingbing, HUANG Fangfang. Summary of the best evidence for early bedside sitting activity plan in mechanically ventilated awake patients[J]. Chinese Journal of Emergency and Critical Care Nursing, 2025, 6(11): 1342-1348.

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参考文献 29

[1]	Nydahl P, Sricharoenchai T, Chandra S, et al. Safety of patient mobilization and rehabilitation in the intensive care unit. Systematic review with meta-analysis[J]. Ann Am Thorac Soc, 2017, 14(5):766-777. doi: 10.1513/AnnalsATS.201611-843SR pmid: 28231030
[2]	Patel BK, Wolfe KS, Patel SB, et al. Effect of early mobilisation on long-term cognitive impairment in critical illness in the USA:a randomised controlled trial[J]. Lancet Respir Med, 2023, 11(6):563-572. doi: 10.1016/S2213-2600(22)00489-1
[3]	卞红, 刘海英, 俞萍, 等. 基于eCASH理念的最小化镇静策略联合早期目标导向活动在ICU机械通气患者中的应用[J]. 中国护理管理, 2022, 22(1):124-128.
	Bian H, Liu HY, Yu P, et al. Implementation of the minimal sedation strategy combined with earlygoal-oriented mobilization based on the eCASH principle in ICU patientsundergoing mechanical ventilation[J]. Chin Nurs Manag, 2022, 22(1):124-128.
[4]	Collings N, Cusack R. A repeated measures,randomised cross-over trial,comparing the acute exercise response between passive and active sitting in critically ill patients[J]. BMC Anesthesiol, 2015, 15(1):1. doi: 10.1186/1471-2253-15-1
[5]	Camargo Pires-Neto R, Fogaça Kawaguchi YM, Sayuri Hirota A, et al. Very early passive cycling exercise in mechanically ventilated critically ill patients:physiological and safety aspects:a case series[J]. PLoS One, 2013, 8(9):e74182. doi: 10.1371/journal.pone.0074182
[6]	杨睿琦, 甘秀妮, 白雪, 等. ICU机械通气患者早期活动相关指南和共识的质量评价与内容分析[J]. 护理学杂志, 2021, 36(6):5-10.
	Yang RQ, Gan XN, Bai X, et al. Quality evaluation and content analysis of guidelines and consensus statements on early mobilization in mechanically ventilated patients in the ICU[J]. J Nurs Sci, 2021, 36(6):5-10.
[7]	Cuthbertson BH, Goddard SL, Lorencatto F, et al. Barriers and facilitators to early rehabilitation in the ICU:a theory driven Delphi study[J]. Crit Care Med, 2020, 48(12):e1171-e1178.
[8]	Lang J. Appraisal of clinical practice guideline:clinical practice guidelines for the prevention and management of pain,agita-tion/sedation,delirium,immobility,and sleep disruption in adult patients in the ICU[J]. J Physiother, 2022, 68(4):282.
[9]	朱政, 胡雁, 邢唯杰, 等. 不同类型循证问题的构成[J]. 护士进修杂志, 2017, 32(21):1991-1994.
	Zhu Z, Hu Y, Xing WJ, et al. Composition of different types of evidence-based problems[J]. J Nurses Train, 2017, 32(21):1991-1994.
[10]	The AGREE next steps consortium[EB/OL].(2017-12-01)[2023-11-23]. https://www.agreetrust.org/wp-content/uploads/2017/12/AGREE-II-Users-Manual-and-23-item-Instrument-2009-Update-2017.pdf.
[11]	张方圆, 沈傲梅, 曾宪涛, 等. 系统评价方法学质量评价工具AMSTAR 2解读[J]. 中国循证心血管医学杂志, 2018, 10(1):14-18.
	Zhang FY, Shen AM, Zeng XT, et al. An Introduction to AMSTAR 2:a critical appraisal tool for systematic reviews[J]. Chin J Evid Based Cardiovasc Med, 2018, 10(1):14-18.
[12]	JBl. Appendix 4.1:JBI critical appraisal checklist for text an-dopinion papers[EB/OL].(2022-06-30)[2023-11-23]. https://jbiglobal-wiki.refined.site/space/MANUAL/4689546/Appendix+4.1%3A+JB\|+Critical+Appraisal+Checklist+for+Text+and+Opinion+Papers.
[13]	王春青, 胡雁. JBI证据预分级及证据推荐级别系统(2014版)[J]. 护士进修杂志, 2015, 30(11):964-967.
	Wang CQ, Hu Y. JBI evidence pre-classification and evidence recommendation level system(2014 edition)[J]. J Nurses Train, 2015, 30(11):964-967.
[14]	Ha TS, Oh DK, Lee HJ, et al. Liberation from mechanical ven-tilation in critically ill patients:Korean Society of Critical Care Medicine Clinical Practice Guidelines[J]. Acute Crit Care, 2024, 39(1):1-23. doi: 10.4266/acc.2024.00052
[15]	王玉光, 叶蕊, 马佳, 等. 床旁端坐法在重症急性胰腺炎机械通气患者中的应用[J]. 中华护理杂志, 2019, 54(6):829-834. doi: 10.3761/j.issn.0254-1769.2019.06.005
	Wang YG, Ye R, Ma J, et al. Effects of bedside wheelchair seating in patients with severe acute pancreatitis combined with mechanical ventilation[J]. Chin J Nurs, 2019, 54(6):829-834. doi: 10.3761/j.issn.0254-1769.2019.06.005
[16]	AHRQ. Early mobility guide for reducing ventilator-associated events in mechanically ventilated patients[EB/OL].(2017-01-01)[2024-01-31]. https://www.ahrq.gov/sites/default/files/wysi-wyg/professionals/quality-patient-safety/hais/tools/mvp/modules/technical/early-mobility-mvpguide.pdf.
[17]	丁楠楠, 姚丽, 张志刚, 等. ICU机械通气患者早期目标导向康复锻炼安全标准的系统评价[J]. 中华危重病急救医学, 2019, 31(1):91-97.
	Ding NN, Yao L, Zhang ZG, et al. Safety criteria for early goal-oriented rehabilition exercise in patients undergoing me-chanical ventilation in intensive care unit:a systematic review[J]. Chin Crit Care Med, 2019, 31(1):91-97.
[18]	Winkelman C, Sattar A, Momotaz H, et al. Dose of early thera-peutic mobility:does frequency or intensity matter?[J]. Biol Res Nurs, 2018, 20(5):522-530. doi: 10.1177/1099800418780492 pmid: 29902939
[19]	Nickels MR, Aitken LM, Walsham J, et al. Exercise interven-tions are delayed in critically ill patients:a cohort study in an Australian tertiary intensive care unit[J]. Physiotherapy, 2020,109:75-84.
[20]	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 libera-tion protocols,and cuff leak tests[J]. Am J Respir Crit Care Med, 2017, 195(1):120-133. doi: 10.1164/rccm.201610-2075ST
[21]	黄海燕, 王小芳, 罗健, 等. ICU机械通气患者早期四级康复训练效果[J]. 护理学杂志, 2016, 31(15):1-5.
	Huang HY, Wang XF, Luo J, et al. Effect of early level 4 rehabilitation training for patients with mechanical ventilation in ICU[J]. J Nurs Sci, 2016, 31(15):1-5.
[22]	Dong ZH, Liu Y, Gai YB, et al. Early rehabilitation relieves diaphragm dysfunction induced by prolonged mechanical ventilation:a randomised control study[J]. BMC Pulm Med, 2021, 21(1):106. doi: 10.1186/s12890-021-01461-2
[23]	付贞艳, 张霞, 胡雁, 等. ICU成人机械通气患者早期康复运动最佳证据总结及临床评价[J]. 中国护理管理, 2020, 20(5):724-730.
	Fu ZY, Zhang X, Hu Y, et al. Clinical evaluation of early rehabilitation exercise for adult patients with mechanical ventilation in ICU:a systematic review and best evidence synthesis[J]. Chin Nurs Manag, 2020, 20(5):724-730.
[24]	Akoumianaki E, Dousse N, Lyazidi A, et al. Can proportional ventilation modes facilitate exercise in critically ill patients? A physiological cross-over study:pressure support versus proportional ventilation during lower limb exercise in ventila-ted critically ill patients[J]. Ann Intensive Care, 2017, 7(1):64. doi: 10.1186/s13613-017-0289-y pmid: 28608135
[25]	韩汝宁, 李秀川, 赵士兵, 等. ICU患者早期康复方案的构建及应用研究[J]. 中华护理杂志, 2020, 55(1):8-15. doi: 10.3761/j.issn.0254-1769.2020.01.001
	Han RN, Li XC, Zhao SB, et al. Construction and application of early rehabilitation scheme for Intensive Care Unit pa-tients[J]. Chin J Nurs, 2020, 55(1):8-15.
[26]	Dong ZH, Yu BX, Zhang QF, et al. Early rehabilitation therapy is beneficial for patients with prolonged mechanical ventila-tion after coronary artery bypass surgery[J]. Int Heart J, 2016, 57(2):241-246. doi: 10.1536/ihj.15-316
[27]	桑明, 卫建华, 张萍, 等. 心脏外科患者术后有创机械通气撤机锻炼体验的质性研究[J]. 中华护理杂志, 2023, 58(16):1970-1976. doi: 10.3761/j.issn.0254-1769.2023.16.009
	Sang M, Wei JH, Zhang P, et al. A qualitative study on the experience of weaning from invasive mechanical ventilation in patients after cardiac surgery[J]. Chin J Nurs, 2023, 58(16):1970-1976. doi: 10.3761/j.issn.0254-1769.2023.16.009
[28]	李鹤, 翁峰霞, 何玲英, 等. 床上功能椅的设计及应用[J]. 中华护理杂志, 2019, 54(9):1431-1433. doi: 10.3761/j.issn.0254-1769.2019.09.031
	Li H, Weng FX, He LY, et al. Design and application of functional chair on bed[J]. Chin J Nurs, 2019, 54(9):1431-1433.
[29]	杨睿琦. ICU机械通气患者早期主动活动安全评估量表的构建及信效度检测[D]. 重庆: 重庆医科大学, 2021.
	Yang RQ. Construction and reliability and validity test of early active activity safety assessment scale for ICU patients with mechanical ventilation[D]. Chongqing: Chongqing Medical University, 2021.