ICU获得性衰弱早期运动干预的最佳证据总结

doi:10.3761/j.issn.2096-7446.2022.04.005

摘要/Abstract

摘要： 目的总结ICU获得性衰弱（intensive care unit acquired weakness,ICU-AW）早期运动干预的最佳证据。方法计算机检索UpToDate、乔安娜布里格斯研究所（Joanna Briggs Institution,JBI）循证卫生保健中心数据库、BMJ Best Practice、美国指南网、英国国家卫生与临床优化研究所、苏格兰院际指南网、加拿大安大略注册护士协会、Cochrane Library、Embase、PubMed、OVID、CINAHL、中国生物医学文献数据库、中国知网、万方数据库、维普数据库关于ICU-AW早期运动干预的文献,包括指南、系统评价、最佳实践信息册、证据总结、专家共识,检索时限为建库至2021年10月,并对纳入文献进行质量评价。结果共纳入相关文献10篇,包括4篇指南、3篇专家共识、1篇最佳实践建议、2篇系统综述。最终形成25条最佳证据,包括评估、多学科合作、适应证、禁忌证、干预前准备、干预方案、安全监测及干预后评价8个方面。结论该研究为ICU-AW早期运动干预提供了循证依据,在临床应用中还需结合患者情况及专业判断,合理应用证据,从而有效预防ICU-AW,改善患者预后。

关键词: 重症监护病房, ICU获得性衰弱, 早期运动, 循证护理学

Abstract: Objective To summarize the best evidence of early exercise intervention for ICU acquired weakness （ICU-AW）. Methods A computer search was performed on UpToDate,Joanna Briggs Institution（JBI） Database of Evidence-Based Health Care Centre,BMJ Best Practice,US Guidelines Network,National Institute for Health and Clinical Excellence（NICE）,Scottish Inter-hospital Guidelines Network,Ontario Registered Nurses Association,Coch-rane Library,Embase,PubMed,OVID,CINAHL,Chinese Biomedical Literature Database,CNKI,Wanfang Database and VIP Database on early ICU-AW exercise intervention,including guidelines,systematic reviews,best practice information volume,evidence summary,expert consensus. The retrieval period was from the database establishment to October 2021,and the quality of the included literature were evaluated. Results A total of 10 related literature were included,including 4 guidelines,3 expert consensus,1 best practice recommendation,and 2 systematic reviews. Finally,25 best evidences were formed,including evaluation,multidisciplinary cooperation,indications,contraindications,pre-intervention preparation,intervention plan,safety monitoring and post-intervention evaluation. Conclusion This study provides an evidence for early ICU-AW exercise intervention. In clinical application,reasonable application of evidence should be combined with patient situation and professional judgment,so as to effectively prevent ICU-AW and improve the prognosis of patients.

Key words: Intensive Care Units, ICU-acquired Weakness, Early Mobilization, Evidence-based Nursing

吉云兰, 徐旭娟, 周水鑫, 薛慧萍, 王伶俐, 张季梅, 朱琴. ICU获得性衰弱早期运动干预的最佳证据总结[J]. 中华急危重症护理杂志, 2022, 3(4): 319-325.

JI Yunlan, XU Xujuan, ZHOU Shuixin, XUE Huipin, WANG Lingli, ZHANG Jimei, ZHU Qin. Summary of the best evidence on early excercise for ICU-acquired weakness[J]. Chinese Journal of Emergency and Critical Care Nursing, 2022, 3(4): 319-325.

参考文献

[1] 苗晓,马靓,徐萍,等. ICU获得性衰弱风险预测模型的研究进展[J]. 中国护理管理,2019,19(1):146-150.
Miao X,Ma L,Xu P,et al.Research progress of risk models for intensive care unit acquired weakness[J]. Chin Nurs Manag,2019,19(1):146-150.
[2] 张成帅,王丽,贾明华,等. 重症监护室获得性衰弱的研究进展[J]. 解放军护理杂志,2016,33(14):46-48,70.
Zhang CS,Wang L,Jia MH,et al.Progress in the study of acquired weakness in the intensive care unit[J]. Nurs J Chin PLA,2016,33(14):46-48,70.
[3] Vanhorebeek I,Latronico N,van den Berghe G. ICU-acquired weakness[J]. Intensive Care Med,2020,46(4):637-653.
[4] Thabet Mahmoud A,Tawfik MAM,Abd El Naby SA,et al. Neurophysiological study of critical illness polyneuropathy and myopathy in mechanically ventilated children;additional aspects in paediatric critical illness comorbidities[J]. Eur J Neurol,2018,25(7):991-e76.
[5] 王颖,江智霞,何礼峰,等. 基于文献计量学的ICU后综合征研究基础及热点梳理[J]. 中华急危重症护理杂志,2020,1(3):258-262.
Wang Y,Jiang ZX,He LF,et al.Bibliometrics analysis of research hotspots on post intensive care syndrome[J]. Chin J Emerg Crit Care Nurs,2020,1(3):258-262.
[6] 江智霞,林凤芝. ICU患者早期活动及其阻碍因素的研究进展[J]. 中华急危重症护理杂志,2020,1(6):508-511.
Jiang ZX,Lin F.Research on early mobilization in ICU patients and analysis of barriers[J]. Chin J Emerg Crit Care Nurs,2020,1(6):508-511.
[7] Patel BK,Pohlman AS,Hall JB,et al.Impact of early mobilization on glycemic control and ICU-acquired weakness in critically ill patients who are mechanically ventilated[J]. Chest,2014,146(3):583-589.
[8] 姚彦蓉,刘娜,郑栋莲,等. 个性化早期活动方案对机械通气患者肌力的影响[J]. 中华急危重症护理杂志,2020,1(6):500-505.
Yao YR,Liu N,Zheng DL,et al.Influence of personalized early mobilization intervention program on muscle strength of patients with mechanical ventilation[J]. Chin J Emerg Crit Care Nurs,2020,1(6):500-505.
[9] 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.Expert consensus on critical rehabilitation in Zhejiang Province[J]. Zhejiang Med J,2017,39(24):2191-2196,2209.
[10] Fan E. Critical illness neuromyopathy and the role of physical therapy and rehabilitation in critically ill patients[J]. Respir Care,2012,57(6):933-944;discussion944-6.
[11] Brouwers MC,Kho ME,Browman GP,et al.AGREE Ⅱ:advancing guideline development,reporting and evaluation in health care[J]. J Clin Epidemiol,2010,63(12):1308-1311.
[12] 胡雁,郝玉芳. 循证护理学[M]. 2版. 北京:人民卫生出版社,2018.
Hu Y,Hao YF.Evidence-based nursing[M]. 2nd ed. Beijing:People's Medical Publishing House,2018.
[13] 顾莺,张慧文,周英凤,等. JBI循证卫生保健中心关于不同类型研究的质量评价工具:系统评价的方法学质量评价[J]. 护士进修杂志,2018,33(8):701-703.
Gu Y,Zhang HW,Zhou YF,et al.JBI evidence-based health center's quality assessment tool for different types of research—the quality evaluation of diagnostic and economic eva-luation[J]. J Nurs Train,2018,33(8):701-703.
[14] Quaile A.NICE QS158:rehabilitation after critical illness in adults[J]. Br J Card Nurs,2018,13(10):476-477.
[15] 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.
[16] Devlin JW,Skrobik Y,Gélinas C,et al.Clinical practice guidelines for the prevention and management of pain,agitation/sedation,delirium,immobility,and sleep disruption in adult pa-tients in the ICU[J]. Crit Care Med,2018,46(9):e825-e873.
[17] 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.
[18] Sommers J,Engelbert RH,Dettling-Ihnenfeldt D,et al.Physiotherapy in the intensive care unit:an evidence-based,expert driven,practical statement and rehabilitation recommendations[J]. Clin Rehabil,2015,29(11):1051-1063.
[19] David Lacomics.Neuromuscular weakness related to critical illness[Z]. UpToDate,2019.
[20] Doiron KA,Hoffmann TC,Beller EM. Early intervention(mobilization or active exercise) for critically ill adults in the intensive care unit[J]. Cochrane Database Syst Rev,2018,3(3):CD010754.
[21] 杨晓龙,邱卓英,邱服冰,等. 基于WHO-FICs的重症患者活动康复:Scoping综述[J]. 中国康复理论与实践,2021,27(4):373-384.
Yang XL,Qiu ZY,Qiu FB,et al.Rehabilitation of mobility for critically ill patients based on World Health Organization family international classifications:a scoping review[J]. Chin J Rehabilitation Theory Pract,2021,27(4):373-384.
[22] Hermans G,de Jonghe B,Bruyninckx F,et al. Interventions for preventing critical illness polyneuropathy and critical illness myopathy[J]. Cochrane Database Syst Rev,2014(1):CD006832.
[23] Stevens RD,Marshall SA,Cornblath DR,et al.A framework for diagnosing and classifying intensive care unit-acquired weakness[J]. Crit Care Med,2009,37(10 Suppl):S299-S308.
[24] 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 rank system(2014 Edition)[J]. J Nurs Train,2015,30(11):964-967.
[25] Tipping CJ,Harrold M,Holland A,et al.The effects of active mobilisation and rehabilitation in ICU on mortality and function:a systematic review[J]. Intensive Care Med,2017,43(2):171-183.
[26] Witteveen E,Wieske L,Sommers J,et al.Early prediction of intensive care unit-acquired weakness:a multicenter external validation study[J]. J Intensive Care Med,2020,35(6):595-605.
[27] 杨丽平,张志刚,张彩云,等. 机械通气患者早期主动活动效果的Meta分析[J]. 中国护理管理,2017,17(6):758-764.
Yang LP,Zhang ZG,Zhang CY,et al.The effect of early active mobilization for patients with mechanical ventilation in Intensive Care Unit:a Meta analysis[J]. Chin Nurs Manag,2017,17(6):758-764.
[28] Ding NN,Zhang ZG,Zhang CY,et al.What is the optimum time for initiation of early mobilization in mechanically ventilated patients? A network meta-analysis[J]. PLoS One,2019,14(10):e0223151.
[29] 查丽玲,周松,王建宁. ICU护士对患者早期活动认知和行为的调查研究[J]. 中华护理杂志,2018,53(2):221-225.
Zha LL,Zhou S,Wang JN.Investigation and analysis on current situation of knowledge and practice for early activities of patients in ICU nurses[J]. Chin J Nurs,2018,53(2):221-225.
[30] 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.
[31] 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.
Han RN,Li XC,Zhao SB,et al.Construction and application of early rehabilitation scheme for intensive care unit patients[J]. Chin J Nurs,2020,55(1):8-15.