非药物治疗干预重症肺炎患者机械通气时间的研究进展

叶 飞扬, 聂 鹏兵
广西中医药大学研究生院

摘要

目的：机械通气作为一种呼吸支持疗法，有效保证重症肺炎患者氧合情况，维持患者生命体征。机械通气虽好，但
同时也带来高感染风险、机械通气时间过长、脱机困难、再次插管通气率高等问题。这对重症肺炎患者的管理带来了极大
挑战和困难。本文就吸气肌训练、早期活动、物理活动方面关于缩短重症肺炎患者机械通气时间进行阐述，旨在为缩短重
症肺炎患者机械通气时间措施提供参考。

关键词

机械通气时间；重症肺炎；吸气肌训练；早期活动；物理活动

参考

[1] 施毅 . 中国成人医院获得性肺炎与呼吸机相关性肺炎诊断和治疗指南 (2018 年版 )[J]. 中华结核和呼吸杂志 ,2018,41(4):255-280.

[2] 刘又宁 . 机械通气相关性肺炎能否与医院获得性肺炎完全分离 [J]. 中华结核和呼吸杂志 ,2018,41(7):513.

[3]Timothy D Girard,Waleed Alhazzani,John P Kress, 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 Liberation Protocols, and Cuff Leak Tests.[J]. American Journal of Respiratory and Critical Care Medicine, 2017, 195(1): 120-133.

[4] 杨玉洁 , 刘桂英 , 李若祎 , 等 .ICU 机械通气患者吸气肌训练的研究进展 [J]. 中国护理管理 ,2020,20(9):1436-1440.

[5]Paulo A F Magalhães,Carlos A Camillo,Daniel Langer, et al. Weaning failure and respiratory muscle function: What has been done and what can be improved?[J]. Respiratory Medicine, 2017, 134: 54-61.

[6]Mariana B Seixas,Leonardo B Almeida,Patrícia F Trevizan, et al. Effects of Inspiratory Muscle Training in Older Adults.[J]. Respiratory Care, 2019, 65(4): 535-544.

[7]Hollebeke Marine-Van,Poddighe Diego,Clerckx Beatrix,et al. High-Intensity Inspiratory Muscle Training Improves Scalene and Sternocleidomastoid Muscle Oxygenation Parameters in Patients With Weaning Difficulties: A Randomized Controlled Trial.[J]. Frontiers in physiology, 2022, 13: 786575.

[8]Stefannie Vorona,Umberto Sabatini,Sulaiman AlMaqbali, et al. Inspiratory Muscle Rehabilitation in Critically Ill Adults. A Systematic Review and Meta-Analysis.[J]. Annals ofthe American Thoracic Society, 2018, 15(6): 735-744.

[9]Bernie M Bissett,Jiali Wang,Teresa Neeman, et al. Which ICU patients benefit most from inspiratory muscle training? Retrospective analysis of a randomized trial.[J]. Physiotherapy Theory and Practice, 2019, 36(12): 1316-1321.

[10]Bernie Bissett,I Anne Leditschke,Margot Green, et al. Inspiratory muscle training for intensive care patients: A multidisciplinary practical guide for clinicians.[J]. Australian Critical Care : Official Journal of the Confederation of Australian Critical Care Nurses, 2018, 32(3): 249-255.

[11]Irini Patsaki,Anna Christakou,Emmanouel Papadopoulos, et al. The combination of inspiratory muscle training and high-flow nasal cannula oxygen therapy forpromoting weaning outcomes in difficult-to-wean patients: protocol for a randomised controlled trial.[J]. Erj Open Research, 2020, 6(3): 00088-2020.

[12]Patricia Arias-Fernández,Macarena RomeroMartin,Juan Gómez-Salgado, et al. Rehabilitation and early mobilization in the critical patient: systematic review.[J]. Journal of Physical Therapy Science, 2018, 30(9): 1193-1201.

[13]Dominik Menges,Bianca Seiler,Yuki Tomonaga, et al. Systematic early versus late mobilization or standard early mobilization in mechanically ventilated adult ICU patients: systematic review and meta-analysis.[J].Critical Care (london, England), 2021, 25(1): 16.

[14]Nannan Ding,Zhigang Zhang,Caiyun Zhang, 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.

[15]Katherine A Doiron,Tammy C Hoffmann,Elaine M Beller. Early intervention (mobilization or active exercise) for critically ill adults in the intensive care unit.[J]. The Cochrane Database of Systematic Reviews, 2018, 2018(3): CD010754.

[16]David E Anekwe,Sharmistha Biswas,André Bussières, et al. Early rehabilitation reduces the likelihood of developing intensive care unit-acquired weakness: a systematic review and meta-analysis.[J]. Physiotherapy, 2019, 107: 1-10.

[17]Ruiqi Yang,Qiulan Zheng,Dan Zuo, et al. Safety Assessment Criteria for Early Active Mobilization in Mechanically Ventilated ICU Subjects.[J]. Respiratory Care, 2020, 66(2): 307-315.

[18]Thais Martins Albanaz da Conceição,Ana Inês Gonzáles,Fernanda Cabral Xavier Sarmento de Figueiredo, et al. Safety criteria to start early mobilization in intensive care units. Systematic review.[J]. Revista Brasileira De Terapia Intensiva, 2017, 29(4): 509-519.

[19]Jonas Monsees,Zena Moore,Declan Patton, et al. A systematic review of the effect of early mobilization on length of stay for adults in the intensive care unit[J]. Nursing in Critical Care, 2022.

[20]Kui Zang,Beibei Chen,Min Wang, et al. The effect of early mobilization in critically ill patients: A meta-analysis.[J].Nursing in Critical Care, 2019, 25(6): 360-367.

[21]Jiani Wang,Dianxu Ren,Yue Liu, et al. Effects of early mobilization on the prognosis of critically ill patients: A systematic review and meta-analysis.[J]. International Journal of Nursing Studies, 2020, 110: 103708.

[22]Macmahon Cortlandt. Breathing and Physical Exercises for Use in Cases of Wounds in the Pleura, Lung and Diaphragm[J]. Lancet, 1915: 769-770.

[23]Denise Battaglini,Chiara Robba,Salvatore Caiffa, et al. Chest physiotherapy: An important adjuvant in critically ill mechanically ventilated patients with COVID-19.[J]. Respiratory Physiology & Neurobiology, 2020, 282: 103529.

[24]Meng-Yang Wang,Lei Pan,Xiao-Juan Hu. Chest physiotherapy for the prevention of ventilator-associated pneumonia: A meta-analysis.[J]. American Journal of Infection Control, 2019, 47(7): 755-760.

[25]Gabriela Ss Chaves,Diana A Freitas,Thayla A Santino, et al. Chest physiotherapy for pneumonia in children.[J]. The Cochrane Database of Systematic Reviews, 2019, 2019(1): CD010277.

[26]Gianluigi Li Bassi,Joan Daniel Martí,Talitha Comaru, et al. Short-Term Appraisal of the Effects and Safety of Manual Versus Ventilator Hyperinflation in an Animal Model of Severe Pneumonia.[J]. Respiratory Care, 2019, 64(7): 760-770.

[27]Schreiber Annia-F,Ceriana Piero,Ambrosino Nicolino,et al. Physiotherapy and Weaning From Prolonged Mechanical Ventilation.[Z], 2018: 17-25.

[28]Lippi Lorenzo,Sire Alessandro-de,D’abrosca Francesco,et al. Efficacy of Physiotherapy Interventions on Weaning in Mechanically Ventilated Critically Ill Patients: ASystematicReviewandMetaAnalysis[J].Frontiersinmedicine, 2022, 9: 889218.

[29]Cui Nianqi,Yan Xiaoli,Zhang Yuping,et al. Non-Pharmacological Interventions for Minimizing Physical Restraints Use in Intensive Care Units: An Umbrella Review.[J]. Frontiers in medicine, 2022, 9: 806945.

[30]Salinee Worraphan,Attalekha Thammata,Kaweesak Chittawatanarat, et al. Effects of Inspiratory Muscle Training and Early Mobilization on Weaning of Mechanical Ventilation: A Systematic Review and Network Meta-analysis.[J]. Archives of Physical Medicine and Rehabilitation, 2020, 101(11): 2002-2014.