危重病患者的低中高强度鼓舞性肌肉训练:系统性审查和元分析
Irini Patsaki1, Alexandros Kouvarakos1,2, Ioannis Vasileiadis2
1Laboratory of Advanced Physiotherapy, Physiotherapy Department, School of Health & Care Sciences, University of West Attica (UNIWA), 12243 Athens, Greece.
Medicina (Kaunas, Lithuania)
|June 27, 2024
概括
启发性肌肉训练 (IMT) 帮助重症患者摆脱机械通风. 低至中等强度的IMT改善了断奶时间,尽管两种强度都没有显著改善最大吸入压力.
科学领域:
- 关键护理医学 关键护理医学
- 呼吸系统生理学 呼吸系统生理学
- 康复科学 康复科学 康复科学
背景情况:
- 在ICU中的机械通风会导致呼吸肌肉衰弱和断奶困难.
- 启发性肌肉训练 (IMT) 旨在加强呼吸肌肉,帮助呼吸机断奶.
- 现有各种IMT协议和设备,需要对其有效性的审查.
研究的目的:
- 在重症患者中,系统地审查和元分析低中等 (LM-IMT) 与高强度 (H-IMT) 门启发性肌肉训练的有效性.
- 为了比较不同IMT强度对呼吸肌肉强度和断奶结果的影响.
- 确定最佳的IMT策略,以改善患者从机械通风中恢复.
主要方法:
- 在过去10年出版的主要数据库 (谷歌学者,PubMed,Scopus,科学直接) 中对RCT进行系统的文献搜索.
- 纳入标准侧重于临界病患者,在LM或HI强度下接受值IMT.
- 使用物理治疗证据数据库 (PEDro) 尺度评估方法质量;在可行的情况下进行元分析.
主要成果:
- 包括14项研究;其中5项具有高方法质量.
- 无论是LM-IMT还是H-IMT都没有显示出最大吸入压力 (MIP) 的统计学上显著改善.
- LM-IMT显示,断奶时间在统计上显著改善,机械通风持续时间在两组之间没有显著差异.
结论:
- 建议ICU患者使用IMT,以预防腹膜功能障碍和促进断奶.
- 虽然LM-IMT对断奶时间产生了积极的影响,但需要进一步的研究来优化IMT协议并提高有效性.
- 需要额外的RCT来探索不同的IMT协议及其对重症患者的特定影响.
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