摘要
Abstract
Objective To analyze the effect of early mobilization and rehabilitation on muscle strength in children with mechanical ventilation and to explore the risk factors affecting muscle strength.Methods A retrospective study was conducted on 104 children with mechanical ventilation admitted to the hospital from April 2021 to April 2023.According to the rehabilitation methods,they were divided into two groups.The clinical data of children with routine rehabilitation training were included in the control group(52 cases),and the clinical data of children with early mobilization and rehabilitation were included in the observation group(52 cases).Both groups were continuously intervened until discharged.The mechanical ventilation time,ICU stay and total hospital stay were compared between the two groups.Muscle strength and self-care ability at different time points(transfer out of ICU,discharge,1 month after discharge),the incidence of acquired weakness(AW)in children with mechanical ventilation were evaluated according to the diagnostic criteria in the Chinese Guidelines for the Diagnosis and Treatment of Myasthenia Gravis.Baseline data was collected and compared between the two groups.Binary logistic regression was used to analyze the risk factors of AW in children with mechanical ventilation.Results The mechanical ventilation time,ICU and total hospitalization time in the observation group[(7.28±2.47)d,(15.27±3.64)d,(27.08±5.68)d]were shorter than those in the control group[(10.64±3.39)d,(17.74±3.55)d,(32.57±6.14)d](P＜0.05).Compared with those at the time of transfer out of ICU and discharge,the Medical Research Council(MRC)scores of the two groups increased at 1 month after discharge,and the MRC scores of the observation group at the time of transfer out of ICU and discharge[(53.57±5.13),(56.84±2.16)]were higher than those of the control group[(50.13±4.57),(53.67±2.42)].There were significant differences between the two groups,time points and between groups·time points(P＜0.05).Compared with those at the time of transferring out of ICU and at discharge,the Barthel scores of the two groups increased at 1 month after discharge,and the Barthel scores of the observation group at the time of transferring out of ICU and at discharge[(65.03±12.47),(90.58±7.59)]were higher than those of the control group[(55.25±11.12),(84.13±9.62)].There were significant differences in Barthel scores between the two groups,time points and groups·time points(P＜0.05).AW occurred in 31 of 104 children with mechanical ventilation during hospitalization,with an incidence of 29.81%.The mechanical ventilation time and Nutritional Risk Screening(NRS)score in the AW group[(11.84±4.19)d,(3.07±1.04)]were higher than those in the non-AW group[(8.18±2.26)d,(1.61±0.75)].The proportion of children with invasive mechanical ventilation mode and the use of rocuronium[77.42%(24/31),32.26%(10/31)]were higher than those in the non-AW group[53.42%(39/73),13.70%(10/73)](P＜0.05).Binary logistic regression analysis showed that long mechanical ventilation time,invasive mechanical ventilation,use of rocuronium and high NRS score were risk factors for AW in children with mechanical ventilation(OR＞1,P＜0.05).Conclusions Early mobilization and rehabilitation can effectively shorten the ventilation time and hospitalization time of patients with mechanical ventilation,improve muscle strength and improve the ability of self-reliance.At the same time,mechanical ventilation time,mechanical ventilation mode,use of rocuronium and NRS score are related to the decrease of muscle strength in children with mechanical ventilation.关键词
机械通气/肌力/早期活动康复/自理能力Key words
mechanical ventilation/muscle strength/early mobilization and rehabilitation/self-care ability
