渐进性早期床上运动对ICU机械通气患者下肢血流速的影响  

Effect of progressive early bed exercise on blood flow in lower limb of patients on mechanical ventilation in intensive care unit

作　　者：吴华炼 陈淼[1] 李晓娟[1] 杨静[1] 陈瑶 肖璇 权明桃[1] Wu Hualian;Chen Miao;Li Xiaojuan;Yang Jing;Chen Yao;Xiao Xuan;Quan Mingtao(Department of lntensive Care Unit,the Affiliated Hospital of Zunyi Medical University,Zunyi 563000,Guizhou,China)

机构地区：[1]遵义医学院附属医院重症医学科,贵州遵义563000

出　　处：《中华危重病急救医学》2018年第10期953-958,共6页Chinese Critical Care Medicine

基　　金：国家临床重点专科建设项目（2013-544）;贵州省遵义市红花岗区科技计划项目（2014-15）

摘　　要：目的 探讨渐进性早期床上运动对重症医学科（ICU）机械通气患者下肢血流动力学的影响.方法 选择2016年2月22日至11月30日入住遵义医学院附属医院综合ICU机械通气≥72 h的成人患者,并按随机数字表法分为试验组和对照组.两组患者均给予抗感染、镇痛镇静、机械通气、营养支持等治疗,并保持四肢功能位,床头抬高等常规活动;试验组在此基础上根据神经、循环及呼吸情况给予Ⅰ-Ⅲ级逐渐增强的早期床上运动治疗,如脚踏车被动/主动运动、直腿抬高运动等,用靶心率评估运动强度,每次15-30 min,每日2次;对照组给予间歇性气压治疗（IPC）,每次30 min,每日2次.于第3天干预前及干预结束后即刻、5、10、15 min测定下肢平均血流速和血流量,于第3天干预前5 min、干预5 min时及干预结束后5、10、 15、30 min测量心率、血压.结果 入选214例患者,剔除干预期间死亡、放弃治疗等患者后,最终有160例纳入数据分析,其中试验组81例,对照组79例.两组患者下肢平均血流速、血流量均增大,而试验组较对照组平均血流速和血流量增大更明显且维持时间更长〔第3天干预前及干预后即刻、5、10、15 min,试验组平均血流速（mm/s）分别为11.92±1.06、18.19±0.17、17.24±0.14、15.48±0.12、12.68±0.16,对照组分别为12.01±1.41、15.65±0.18、12.91±0.14、12.13±0.12、11.59±0.16,时间效应F＝1 043.101、P＝0.000,干预效应F＝151.001、P＝0.000,干预与时间的交互效应F＝224.830、P＝0.001 ;试验组血流量（mL/min）分别为3.39±0.96、5.59±0.11、5.16± 0.12、4.19±0.10、3.35±0.09,对照组分别为3.28±0.82、4.04±0.11、3.40±0.12、3.02±0.10、3.00±0.10,时间效应F＝680.405、P＝0.000,干预效应F＝125.359、P＝0.000,干预与时间的交互效应F＝79.631、P＝0.012〕.两组患者在干预过程中心率、血压均呈先升高后降低再缓慢恢复至干预前的变化趋势,但试验组指标波动Objective To investigate the effect of progressive early bed physical activity on blood flow in lower limb of patients on mechanical ventilation in intensive care unit （ICU）. Methods Adult patients with mechanical ventilation ≥ 72 hours admitted to ICU of the Affiliated Hospital of Zunyi Medical University from February 22nd to November 30th, 2016 were enrolled. The patients were randomly divided into experimental group and control group by random number table method. Patients in the two groups were given the same basic treatment, including antibiotics, analgesia and sedation, mechanical ventilation, nutritional support, and routine ICU activities such as maintaining functional position of limbs and raising of bed head. On the basis of those, the experimental group was given early bed physical activity with gradual enhancement of grades Ⅰ-Ⅲ according to the nerve, circulation and respiration situations, such as passive/active exercise of the bicycle, straight leg lifting exercise, etc. The exercise intensity was evaluated with target heart rate, and the exercise was performed for 15-30 minutes at a time, twice a day. The control group was given intermittent pneumatic compression （IPC）, 30 minutes in each time, twice a day. Mean blood flow and blood volume were measured before and immediately, 5, 10 and 15 minutes after intervention on the 3rd day. Heart rate and blood pressure were measured at 5 minutes before intervention, during 5 minutes, and 5, 10, 15, 30 minutes after intervention on the 3rd day. Results 214 adult patients were selected, after excluding the patients who died during the intervention or gave up treatment, 160 patients were included in the data analysis, with 81 in the experimental group and 79 in the control group. The mean blood flow velocity and blood volume were increased in both groups, and the mean blood flow velocity and blood flow volume in the experimental group were significantly increased and lasted longer than those in the control group [mean blood flow velocity （mm/

关 键 词：渐进性早期床上运动 机械通气 平均血流速 血流量 

分 类 号：R459.7[医药卫生—急诊医学]