下肢部位神经肌肉电刺激对ICU机械通气患者影响的Meta分析

来源 :中华危重病急救医学 | 被引量 : 0次 | 上传用户:zsq789456
下载到本地 , 更方便阅读
声明 : 本文档内容版权归属内容提供方 , 如果您对本文有版权争议 , 可与客服联系进行内容授权或下架
论文部分内容阅读
目的:采用Meta分析方法评价下肢部位神经肌肉电刺激(NMES)对重症监护病房(ICU)机械通气患者的有效性。方法:应用计算机检索Cochrane图书馆数据库、美国国立医学图书馆PubMed数据库、科学网(Web of Science)、荷兰医学文摘Embase数据库、中国生物医学文献服务系统(SinoMed)、中国知网(CNKI)、维普中文科技期刊数据库(VIP)和万方数据中,从建库至2021年5月公开发表的有关ICU机械通气患者下肢部位进行NMES效果的随机对照试验(RCT)。对照组实施常规康复措施;观察组在常规康复措施基础上进行下肢部位NMES。由2名研究者独立筛选文献、提取资料并评价纳入研究的偏倚风险后,采用RevMan 5.3软件进行Meta分析;绘制漏斗图分析文献发表偏倚。结果:最终纳入8篇RCT,文献质量评价结果显示,1项研究为A级,7项研究为B级,提示纳入文献质量相对较高。Meta分析结果显示,与对照组比较,下肢部位NMES能够有效缩短ICU患者机械通气时间〔标准化均数差(n SMD)=-0.51,95%可信区间(95%n CI)为-0.72~-0.31,n P<0.000 01〕,提高最大吸气压〔MIP;均数差(n MD)=14.19,95%n CI为9.30~19.09,n P<0.000 01〕,改善患者运动功能状态〔ICU运动功能状态评分(FSS-ICU);n MD=10.44,95%n CI为3.12~17.77,n P=0.005〕,差异均具有统计学意义;然而,在提高MRC肌力评估量表评分(MRC评分;n MD=2.13,95%n CI为-1.38~5.63,n P=0.23)、降低ICU病死率〔相对危险度(n RR)=0.80,95%n CI为0.51~1.24,n P=0.31〕、缩短ICU住院时间(n MD=-0.54,95%n CI为-3.67~2.59,n P=0.74)等方面均未见明显优势,合并效应无统计学意义。基于患者机械通气时间相关文献绘制漏斗图显示,纳入文献分布基本对称,未检测到发表偏倚。n 结论:下肢部位NMES能有效缩短ICU机械通气患者的机械通气时间,提高MIP及运动功能状态,但对MRC评分、ICU病死率及ICU住院时间无明显影响。未来仍需开展高质量、大样本、多中心的RCT对研究结果加以论证。“,”Objective:To evaluate the effect of lower limb neuromuscular electrical stimulation (NMES) on mechanical ventilation patients in intensive care unit (ICU).Methods:Databases including the Cochrane Library, PubMed, Web of Science, Embase, SinoMed, CNKI, VIP and Wanfang database were searched from inception to May 2021. Randomized controlled trails (RCT) about the influence of NMES of lower limbs in patients with mechanical ventilation in ICU were collected. Routine rehabilitation measures were implemented in the control group, while the combination of routine rehabilitation and NMES on the lower limbs was implemented in the observation group. The literature screening, data extracting, and bias risk assessment of included studies were conducted independently by two reviewers. RevMan 5.3 software was used to perform Meta-analysis. Funnel plot was used to test publication bias.Results:A total of 8 RCT were eventually enrolled. The literature quality evaluation results showed that 1 study was grade A and 7 studies were grade B, suggesting that the quality of the included literature was relatively high. The Meta-analysis results showed that NMES in the lower extremities could effectively shorten the duration of mechanical ventilation in ICU patients [standardized mean difference (n SMD) = -0.51, 95% confidence interval (95%n CI) was -0.72 to -0.31, n P < 0.000 01], increase the maximum inspiratory pressure [MIP; mean difference ( n MD) = 14.19, 95%n CI was 9.30 to 19.09, n P < 0.000 01], and improve the functional status of critically ill patients [functional status score for ICU (FSS-ICU); n MD = 10.44, 95%n CI was 3.12 to 17.77, n P = 0.005] with statistically significances. However, there were no significant advantages in increasing the Medical Research Council (MRC) score (n MD = 2.13, 95%n CI was -1.38 to 5.63, n P = 0.23), reducing ICU mortality [relative risk (n RR) = 0.80, 95%n CI was 0.51 to 1.24, n P = 0.31], shortening length of ICU stay (n MD = -0.54, 95%n CI was -3.67 to 2.59, n P = 0.74), and the combined effect was not statistically significant. Funnel plot based on the duration of mechanical ventilation showed that the distribution of included articles was basically symmetrical, and no publication bias was detected.n Conclusions:NMES of the lower limbs can not only shorten the ventilation duration effectively, but also improve the MIP and functional status of mechanically ventilated patients in ICU. However, it has no significant effect on the MRC score, ICU mortality and length of ICU stay of patients with mechanical ventilation. In the future, high-quality, large sample size and multi-center RCT are needed to verify the effects of NMES.
其他文献
期刊
期刊
急性呼吸窘迫综合征(ARDS)在临床具有发病率高、病死率高的特点,是导致重症患者死亡的重要因素之一。探索ARDS早期预警、严重程度及预后评估的生物学标志物(组)是研究的重点和难点。代谢紊乱与代谢支持在危重症救治中被日益重视,越来越多的研究表明维生素及其代谢产物变化可动态反映ARDS的损伤环节,并将为ARDS早期诊断、动态评估,乃至特异性治疗靶点筛选提供新的切入点。维生素代谢组学作为代谢组学的重要分支,有助于更好地寻找ARDS的潜在生物标志物。代谢组学是精准医学的最新技术手段,运用代谢组学方法分析维生素代谢
心肺复苏(CPR)指南强调:在抢救心搏骤停患者实施CPR时,应尽早启动胸外心脏按压;同时强调用力按压,快速按压,使胸廓充分回弹,尽量减少按压中断时间。现有机械复苏装置存在按压位置容易偏移、价格昂贵、不易搬动及活塞易脱位等问题;而徒手CPR因高强度的体力损耗,会导致胸外按压深度和频率随着CPR时间延长而下降,从而造成CPR失败;此外,非专业医护人员进行CPR时,大多存在按压位置有偏差、按压深度不准确、胸壁回弹不理想等问题。基于以上因素,解放军总医院第八医学中心重症医学科的医护人员以国际CPR指南为标准,根据
急性肺损伤/急性呼吸窘迫综合征(ALI/ARDS)是以顽固性低氧血症为特征、严重威胁患者生命的肺部疾病。代谢组学是对生物或细胞内小分子质量代谢物进行定性和定量分析的一门新兴学科,在疾病发生及诊断中的作用受到越来越多的重视。近年来,许多基于代谢组学筛选出的代谢产物被提出可作为潜在的生物标志物,用于评估ALI/ARDS的早期发展及预后,并为新的靶向干预措施提供依据。本文基于代谢组学探讨内源性代谢物在ALI/ARDS发病机制及生物标志物中的作用,并对其在药物治疗中的应用进行综述。“,”Acute lung in
期刊
期刊
目的:通过对河北省石家庄市治疗新型冠状病毒肺炎(新冠肺炎)的中药处方进行数据分析,以期进一步指导临床运用中医药防治新冠肺炎。方法:将河北省中医院重症医疗队2021年1月7日至3月4日在河北省新冠肺炎定点救治医院河北省胸科医院重症监护病房(ICU)救治的确诊为新冠肺炎的48例出院患者为研究对象。收集患者的性别、年龄、临床分型、既往史以及住院期间首诊和复诊的全部中药处方。基于古今医案云平台(V2.2.1)建立数据库,用频次统计、关联分析、聚类分析、复杂网络分析等方法,对中药处方进行分析。结果:48例确诊新冠肺
目的:探讨伴慢性阻塞性肺疾病(COPD)稳定期术后患者入重症监护病房(ICU)的风险。方法:选择2014年3月至2020年12月中国医科大学附属盛京医院收治的拟行外科手术的COPD稳定期患者。基于慢性阻塞性肺疾病全球倡议(GOLD)指南标准,按照术前气流受限程度分为1级〔第1秒用力呼气容积占预计值百分比(FEV1%)≥80%〕、2级(50%≤FEV1%<80%)、3级(30%≤FEV1%<50%)、4级(FEV1%<30%);基于2021年修订版COPD诊治指南,结合患者症状水平和1年内中、重度急性加重史
目的:比较经鼻高流量湿化氧疗(HFNC)与无创正压通气(NIPPV)在慢性阻塞性肺疾病急性加重(AECOPD)致严重呼吸衰竭(SRF)患者早期拔管后序贯治疗中的优劣,为临床选择优化方案提供依据。方法:选择2019年1月至2020年9月新疆医科大学第一附属医院呼吸重症监护病房(RICU)连续入院的年龄40~85岁、以支气管肺部感染为急性加重原因且初始呼吸支持方式为气管插管机械通气(ETI-MV)的AECOPD致SRF患者作为研究对象。通气模式为同步间歇指令通气(SIMV),参数设置为潮气量(VT)8 mL/