肢体功能锻炼在机械通气患者应用的系统评价.docVIP

运动疗法干预机械通气患者随机对照试验的meta分析 【摘要】目的 采用meta分析方法综合评价运动干预与传统干预对机械通气患者的监测效果。方法 制定原始文献的纳入标准、排除标准和检索策略、检索多个数据库，获得运动干预机械通气患者的临床随机对照试验，进行文献评价后，采用RewMan5.0软件进行数据分析。结果 共检出202篇文献相关文献，经筛选最终纳入4篇进行Meta分析。分析显示：运动干预对机械通气患者的握力、抬腿时间均优于传统干预。其WMD（95%CL）分别为22.87（1.39,44.35）、5.27（0.77，9.77）；对患者PaCO2的比较，差异不具有统计学意义，但显示运动疗法有降低患者PaCO2的趋势；结论：本研究显示，实施运动疗法干预机械通气患者的效果有优于传统干预的趋势，由于目前开展的较少，需要大样本、多中心的随机对照试验来确认这种趋势。 【关键词】运动疗法；通气机，机械；Meta分析；随机对照试验 Effects of exercise therapy for patients using mechanical ventilation：A Meta-Analysis 【Abstracts】Objective To assess the effect of exercise therapy and traditional methods in patients using mechanical ventilation by meta—analysis. Methods Many kinds of databases were researched and all the randomized controlled trials were included，which compared exercise therapy patients using mechanical ventilation．After evaluation of the quality of included studies and extraction of the data，the soft ware of Review Manager 5.0 was used to analyze those outcomes. Results A total of 202 articles were retrieved, but only 4 were included. Meta-analysis showed that there was no difference between exercise therapy and traditional methods reduce PaCO2 in patients, but exercise therapy was superior to traditional methods in the training of grip(WMD22.87,95%CL 1.39 to 44.35) and the time of raise the legs(WMD5.27, 95%CL 0.77 to 9.77).Conclusion exercise therapy tends are associated with better rehabilitation outcome among patients compared with traditional methods. However, only a few articles were included, so large-scale randomized controlled trials of higher quality are needed to confirm this. 【Key words】Exercise therapy；Ventilators，Mechanical；Meta-Analysis；Randomized Controlled Trials 机械通气（Mechanical Ventilation，MV）是建立气道口与肺泡间的压力差，通过呼吸道开口直接实施压力，吸气时气体被正压压入肺泡，呼气时气体随胸廓和肺脏的被动回缩而排出体外[]。在美国，每年有100—300万的患者需要应用机械通气（不包括手术中应用的患者）。在我国各重症监护病（ICU）中，大约有50000台呼吸机。近年来机械通气的范围还在扩大，尤其是老年人、外科手术以及免疫治疗后[]。在健康成人中，肌肉大约能占到体重的45%。在完全期间，肌肉重量每周减少5%，以这样的下降，骨骼肌强度每天以1?1.5%的速度下降[]12h、24h、48h、72h时分别下降了18％、25％