Efficacy of neuromuscular electrical stimulation in patients with COPD followed in intensive care unit
Efficacy of neuromuscular electrical stimulation in patients with COPD followed in intensive care unit
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DOI：
10.1111/crj.12411
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发表时间：
2017-11-01
影响因子：
1.7
通讯作者：
Unlu, Mehmet
中科院分区：
文献类型：
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作者：
Akar, Olcay;Gunay, Ersin;Unlu, Mehmet
慢性阻塞性肺疾病（COPD）卧床患者接受机械通气可出现严重的肌肉力量和功能状态问题。我们的目的是研究主动肢体活动和神经肌肉电刺激（NMES）对接受机械通气的COPD患者的脱机过程、出院和炎症介质的影响。方法选择30例经重症监护病房（ICU）诊断为呼吸衰竭的有意识COPD患者（F/M:15/15）作为研究对象。患者随机分为三组，每组10例。第1组采用主动肢体运动训练和NMES，第2组仅采用NMES，第3组采用主动肢体运动训练。评估肌肉力量、活动时间和断奶情况。测定血清细胞因子水平。结果组1 （3.00 ~ 5.00，P=0.014）和组2 （4.00 ~ 5.00，P=0.046）下肢肌力明显改善。三组上肢肌力均显著提高（各组分别从4.00提高到5.00，P=0.038、P=0.046和P=0.034）。两组患者的动员时间和出院时间相似。康复后1组血清白细胞介素(IL)-6水平显著降低，1、2组血清IL-8水平显著降低。结论肺部康复可预防ICU患者肌力丧失。然而，我们认为需要在更大的人群中进行进一步的研究，以检查NMES和/或主动和被动肌肉训练对卧床的ICU机械通气患者的影响。
IntroductionSerious problems on muscle strength and functional status can be seen in bedridden-patients with chronic obstructive pulmonary diseases (COPD) receiving mechanical ventilation. We aimed to investigate the impact of active extremity mobilization and neuromuscular electrical stimulation (NMES) on weaning processes, discharge from hospital and inflammatory mediators in COPD patients receiving mechanical ventilation.MethodsThirty conscious COPD patients (F/M:15/15) hospitalized in the intensive care unit (ICU) with diagnosis of respiratory failure were enrolled to this study. Patients were randomized into three groups, including 10 patients for each. Active extremity-exercise training and NMES were applied to Group-1, only NMES was applied to Group-2 and active extremity exercise training was applied to Group-3. Muscle strengths, mobilization duration and weaning situation were evaluated. Serum cytokine levels were evaluated.ResultsLower extremity muscle-strength was significantly improved in Group-1 (from 3.00 to 5.00, P=0.014) and 2 (from 4.00 to 5.00, P=0.046). Upper extremity muscle strength was also significantly improved in all three groups (from 4.00 to 5.00 for all groups, P=0.038, P=0.046 and P=0.034, respectively). Duration of mobilization and discharge from the ICU were similar among groups. There was a significant decrease in serum interleukin (IL)-6 level in Group-1 and in serum IL-8 level in Group-1 and Group-2 after rehabilitation.ConclusionThis study indicates that pulmonary rehabilitation can prevent loss of muscle strength in ICU. Nevertheless, we consider that further studies with larger populations are needed to examine the impact of NMES and/or active and passive muscle training in bedridden ICU patients who are mechanically ventilated.