早期康复训练对老年脓毒性休克患者血压的影响——一项单中心前瞻性随机对照研究  

Effect of early rehabilitation exercise on blood pressure of elderly patients with septic shock:a single-center,prospective,randomized controlled study

作　　者：汪正光 姚建华[1] 陈晓燕[1] 汪国斌[1] 邢芳芳 Wang Zhengguang;Yao Jianhua;Chen Xiaoyan;Wang Guobin;Xing Fangfang(Department of Critical Care Medicine,Huangshan Shoukang Hospital(High-tech Zone Central Hospital of Huangshan),Huangshan 245000,Anhui,China)

机构地区：[1]黄山首康医院(黄山高新区中心医院)重症医学科,安徽黄山245000

出　　处：《中华危重病急救医学》2021年第9期1116-1120,共5页Chinese Critical Care Medicine

摘　　要：目的观察早期康复训练对老年脓毒性休克患者血压的影响。方法采用单中心前瞻性随机对照研究方法。选择2018年12月至2020年11月在黄山首康医院(黄山高新区中心医院)重症医学科住院的老年脓毒性休克患者作为研究对象。按照简单随机原则将患者分为对照组和干预组。两组均给予双下肢气压治疗预防深静脉血栓,每日3次,每次30 min。患者经重症监护病房(ICU)综合治疗病情逐渐好转,血流动力学相对稳定后去甲肾上腺素减量至0.5μg·kg-1·min-1,对照组继续给予双下肢气压治疗不进行康复训练;干预组在去甲肾上腺素减量至0.5μg·kg-1·min-1时开始进行康复训练。观察两组患者去甲肾上腺素使用时间、ICU住院时间以及干预组康复训练时不良事件的发生情况。结果72例患者被纳入最后分析,干预组35例,对照组37例。两组性别构成、年龄、牛津急性疾病严重程度评分(OASIS)、急性生理学与慢性健康状况评分Ⅱ(APACHEⅡ)、3个时间点平均动脉压(MAP)和基础疾病比较差异均无统计学意义。与对照组比较,干预组ICU住院时间和去甲肾上腺素使用剂量≤0.5μg·kg-1·min-1的时间明显缩短〔ICU住院时间(h):193.0(145.5,312.0)比242.5(180.0,483.5),P<0.05;去甲肾上腺素使用剂量≤0.5μg·kg-1·min-1的使用时间(h):120.0(72.0,144.0)比144.5(120.0,192.0),Z=2.976,P=0.003〕。干预组35例患者在康复期间未出现急性心肌梗死、心律失常、晕厥、中心静脉导管脱落和胃管脱落现象,1例患者因牵拉导尿管出现肉眼血尿,经对症处理后次日消失。结论早期康复训练有助于老年脓毒性休克患者恢复自主血压,缩短去甲肾上腺素使用时间和ICU住院时间。Objective To observe the effect of early rehabilitation exercise on blood pressure of elderly patients with septic shock.Methods A single-center,prospective,randomized controlled study was conducted in elderly patients with septic shock who were hospitalized in the department of critical care medicine of Huangshan Shoukang Hospital(High-tech Zone Central Hospital of Huangshan)from December 2018 to November 2020.According to the principle of simple random,all patients were divided into control group and intervention group.Both groups were treated with lower limb barometry to prevent deep vein thrombosis,3 times a day,30 minutes each time.After comprehensive treatment in the intensive care unit(ICU),the severity of patients was gradually improved,the hemodynamics was relatively stable,and the norepinephrine was reduced to 0.5μg·kg-1·min-1.The control group continued to receive lower limb barometric treatment without rehabilitation training,while the intervention group began rehabilitation training when the dose of norepinephrine was reduced to 0.5μg·kg-1·min-1.The duration of norepinephrine use,the length of ICU stay,and the occurrence of adverse events during rehabilitation training in intervention group was recorded.Results Seventy-two patients were included in the final analysis,35 in intervention group and 37 in control group.There was no significant difference in gender,age,Oxford acute severity of illness score(OASIS),acute physiology and chronic health evaluationⅡ(APACHEⅡ),mean arterial pressure(MAP)of 3 times and underlying diseases between two groups.Compared with control group,the length of ICU stay and duration of dose of norepinephrine≤0.5μg·kg-1·min-1 in intervention group were significantly shorter[length of ICU stay(hours):193.0(145.5,312.0)vs.242.5(180.0,483.5),P<0.05;duration of dose of norepinephrine≤0.5μg·kg-1·min-1(hours):120.0(72.0,144.0)vs.144.5(120.0,192.0),Z=2.976,P=0.003].In intervention group,35 patients did not show acute myocardial infarction,arrhythmia,syncope,centra

关 键 词：康复训练 老年患者 脓毒性休克 血压 去甲肾上腺素 随机对照研究 

分 类 号：R459.7[医药卫生—急诊医学] R493[医药卫生—治疗学]