ICU机械通气患者早期活动与预后两个国家、多中心、前瞻性队列研究刘松桥，陈齐红翻译邱海波审校Introduction: The aim of this study was to investigate current mobilization practice, strength at ICUdischarge and functional recovery at 6 months among mechanically ventilated ICUpatients.目的：探讨ICU机械通气患者住院时早期活动情况及出ICU时力量与6个月功能恢复之间的关系。Method: This was aprospective, multi-centre, cohort study conducted in twelve ICUs in Australiaand New Zealand. Patients were previously functionally independent and expectedto be ventilated for >48 hours. We measured mobilization during invasiveventilation, sedation depth using the Richmond Agitation and Sedation Scale(RASS), co-interventions, duration of mechanical ventilation, ICU-acquiredweakness (ICUAW) at ICU discharge, mortality at day 90, and 6-month functionalrecovery including return to work.方法：本研究为澳大利亚和新西兰12个ICU进行的前瞻性、多中心、队列研究，纳入发病前肢体活动功能正常，预计机械通气时间大于48h的患者。评估有创机械通气时活动程度、采用RASS评价镇静深度，记录合并治疗、机械通气持续时间、转出ICU时是否出现ICU获得性肌无力(ICUAW)，90天病死率以及6个月(包括恢复工作后)功能恢复情况。Results: We studied 192patients (mean age 58.1 ± 15.8 years; mean Acute Physiology and Chronic HealthEvaluation (APACHE) (IQR) II score, 18.0 (14 to 24)). Mortality at day 90 was26.6% (51/192). Over 1,351 study days, we collected information during 1,288planned early mobilization episodes in patients on mechanical ventilation forthe first 14 days or until extubation (whichever occurred first). We recordedthe highest level of early mobilization. Despite the presence of dedicatedphysical therapy staff, no mobilization occurred in 1,079 (84%) of theseepisodes. Where mobilization occurred, the maximum levels of mobilization wereexercises in bed (N = 94, 7%), standing at the bed side (N = 11, 0.9%) orwalking (N = 26, 2%). On day three, all patients who were mobilized weremechanically ventilated via an endotracheal tube (N = 10), whereas by day five50% of the patients mobilized were mechanically ventilated via a tracheostomytube (N = 18). In 94 of the 156 ICU survivors, strength was assessed at ICUdischarge and 48 (52%) had ICU-acquired weakness (Medical Research CouncilManual Muscle Test Sum Score (MRC-SS) score <0.0001).结果：本研究共纳入192例患者(平均年龄58.1±15.8岁，平均APACHE评分18(14~24)。90天病死率为26.6%(51/192)。在1351个研究日内，记录患者机械通气14天内或拔管前(机械通气14天或拔管前取其短)的共1288次计划早期活动事件，并记录机械通气患者早期活动最大程度。结果发现尽管有专业理疗师参与，仍有1079(84%)次患者没有进行早期活动。而进行早期活动患者的最高程度是卧床锻炼(N=94，7%)，站立(N=11，0.9%)或者散步(N=26，2%)。在机械通气第三天活动的患者都是经气管插管进行机械通气(N=10)，而在机械通气第五天，50%活动患者是经气管切开进行机械通气。 156例存活患者中有94例存活患者在出ICU时进行了活动力量的评价，其中48例(52%)发生了ICU获得性肌无力(医学研究理事会人工肌肉测试评分，MRC-SS<48/60)。进行早期活动的机械通气患者MRC-SS评分明显高于未活动的患者(50±11.2比42.0±10.8，P=0.003)。另外，出ICU时存活而在90天内死亡患者平均MRC评分(28.9±13.2)明显低于90天存活患者(44.9±11.4，P<0.0001)。Conclusions: Earlymobilization of patients receiving mechanical ventilation was uncommon. Morethan 50% of patients discharged from the ICU had developed ICU-acquiredweakness, which was associated with death between ICU discharge and day-90.结论：ICU内机械通气患者早期活动较少。超过50%的出ICU患者出现ICU获得性肌无力，ICU获得性肌无力与患者出ICU 后90天内死亡相关。
