蛋白质、肌肉康复及躯干神经肌肉电刺激对长期机械通气患者的影响：一项前瞻性、随机对照预试验研究。
完整摘要 · 中文译文
背景：对于长期机械通气（PMV）患者，减轻膈肌功能障碍至关重要。蛋白质补充、核心肌群康复和神经肌肉电刺激（NMES）在PMV患者中的临床影响尚不清楚。 研究设计与方法：我们开展了一项针对危重症PMV患者的单中心、前瞻性、随机对照预试验研究。所有入组患者被随机分为四组：（1）常规护理（UC）+高蛋白饮食（HP）；（2）UC + HP +核心肌群康复；（3）UC + HP +核心肌群康复+ NMES；（4）UC。干预措施持续21天。主要结局为成功脱离呼吸机及机械通气持续时间。次要结局为住院时间和院内死亡率。 结果：共入组100例患者，其中UC组10例，其余三组各30例。9例患者提前退出试验。核心肌群康复和NMES的平均依从率接近90%。第3组患者的脱机率最高，其次为第2组和第1组，且与第4组相比差异有统计学意义（87%、73%、67%和30%，p = 0.0071）。第3组患者的机械通气持续时间也最短，其次为第1组和第2组，且与第4组相比差异有统计学意义（41.1 ± 12.9、56.5 ± 24.1、57.1 ± 29.9和74.4 ± 27.1天，p = 0.0006）。四组的住院时间和院内死亡率相当。 结论：将高蛋白补充、核心康复与神经肌肉电刺激（NMES）相结合是可行的，并可能有助于长期机械通气（PMV）患者的呼吸机脱机。有必要开展更大规模的多中心随机试验。 临床试验注册号：本试验已在 ClinicalTrials.gov 注册（NCT05932134，2023 年 9 月），现已停止纳入新受试者。
完整摘要 · 英文原文
BACKGROUND: Attenuating diaphragmatic dysfunction is important in patients with prolonged mechanical ventilation (PMV). The clinical impact of protein supplementation, core muscle rehabilitation and neuromuscular electrostimulation (NMES) in patients with PMV remains unknown. STUDY DESIGN AND METHODS: We conducted a single center, prospective, randomized controlled pilot study for critically ill patients with PMV . All enrolled patients were randomly assigned into four groups: (1) usual care (UC) + high-protein diet (HP); (2) UC + HP + core muscle rehabilitation; (3) UC + HP + core muscle rehabilitation + NMES; and (4) UC. The interventions were maintained for 21 days. Primary outcomes were successful weaning from the ventilator and the duration of mechanical ventilation. Secondary outcomes were length of hospital stay and in-hospital mortality. RESULTS: A total of 100 patients were enrolled, with 10 in the UC group and 30 each in the other three groups. Nine patients discontinued the trial early. The mean compliance rates of core muscle rehabilitation and NMES were nearly 90%. The patients in group 3 had the highest weaning rate followed by group 2 and group 1, and the difference was significant compared to group 4 (87%, 73%, 67% and 30%, p = 0.0071). The patients in group 3 also had the shortest duration of mechanical ventilation followed by group 1 and group 2, and the difference was significant compared to group 4 (41.1 ± 12.9, 56.5 ± 24.1, 57.1 ± 29.9 and 74.4 ± 27.1 days, p = 0.0006). The length of hospital stay and in-hospital mortality were comparable in the four groups. CONCLUSION: Combining high-protein supplementation, core rehabilitation, and NMES is feasible and may facilitate ventilator weaning in PMV patients. Larger multicenter randomized trials are warranted. CLINICAL TRIAL REGISTRATION NUMBER: This trial was registered with ClinicalTrials.gov (NCT05932134, Sep 2023) and is closed to new participants.