| Summary: | 碩士 === 長庚大學 === 臨床醫學研究所 === 103 === The influence of limb muscle electrical stimulation treatment on patients with prolonged mechanical ventilation
Purpose:Critical illness polyneuropathy and myopathy (CIPNM) caused muscular weakness. It affects both limbs and respiratory muscle, also lead to difficult weaning ventilator, thus may be a severe complication of long tome care. Our study is aimed at the cases that prolong use of ventilator and difficult for weaning and to understanding the condition of muscle weakness and examine the impact on muscle strength and prognosis of this treatment after muscle electrical stimulation (EMS) intervention.
Methods:Select the cases in ICU that used mechanical ventilator for more than 21 days and were in weaning difficulty. After transferred to respiratory care center within 24-48 hours, randomly assigned to electrical muscle stimulation (EMS) group and the control group. The treatment was continued 48 hours after weaning ventilator or patients left respiratory care center. The study will collect information of hospitalization, the prognosis and detection of blood chemistry and biological markers.
Results: This study from March 2013 to June 2014, certain areas of the hospital respiratory care center received a total of 13 cases of difficult weaning. Patients after receiving limb muscle electrical stimulation treatment, the muscle strength score (Medical Research Council, MRC score) was higher than the control group (54.85 ± 9.0 vs. 46.50 ± 11.67, P = 0.05), but there was no effect on blood cytokine IL-6, IGF-1, IL-10. The cases that left the respiratory care center and were diagnosed with CIPNM, blood cytokine IL-6 was significantly higher than those who was not CIPNM (P = 0.02). The lower of the limb muscle strength score (MRC), the blood cytokine IL-6 is higher. Both have significant negative correlation (R2 = 0.732, P = 0.0001). The study concluded that those who had CIPNM and had a significantly higher re-entry rate to ICUs (75% vs 0%, P = 0.003). The patient that re-entry to ICU had lower limb muscle strength (MRC) by (33.67 ± 4.04 vs.55.7 ± 5.67, P = 0.01) and had higher cytokine IL-6, IL-10 and lower IGF- 1 (P = 0.01). Besides, patients with CIPNM had a lower left and right hand mean grip strength (2.33 ± 2.72 vs 7.85 ± 3.05 Kgs, P = 0.002). The mean left and right hand grip strength and limb muscle strength scores significantly related (R2 = 0.68, P < 0.001).
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