ICU重症患者早期活动的可行性研究

目的 探讨在ICU内开展重症患者早期活动的安全性和可行性,以期为在ICU开展早期活动提供参考。 方法 选取2014年8月—2015年2月收住ICU 24 h后符合早期活动标准的危重患者32例,根据相关标准进行早期活动共81例次。每日评估患者肌力情况,结合患者病情确定早期活动级别;按照循序渐进原则,在患者能耐受且生命体征无明显波动的前提下,逐渐提高活动级别(从在护士协助下床上坐起到独立下床行走,共4个运动级别),观察并记录患者活动前后即刻心律(HR)、呼吸(RR)、经皮血氧饱和度(SpO₂)、血压(BP)等指标,倾听患者主观感受以及有无头晕、乏力、疼痛等不适,观察有无管道滑脱、跌倒、病情突然恶化等不良事件。 结果 81例次早期活动中,1级活动64例次,2级活动6例次,3级活动10例次,4级活动1例次;51例次患者感受良好,26例次患者感觉轻度不适但能耐受,4例次患者不能耐受;发生静脉炎1例,无跌倒、管道滑脱等严重不良事件发生。活动前后HR、RR、SpO₂、舒张压(DBP)差异无统计学意义(P>0.05),收缩压(SBP)升高,与活动前比较,差异有统计学意义(P=0.010);77例次患者能耐受;未发生一例严重不良事件。 结论 按一定标准与流程为ICU患者实施早期活动是安全、可行的,患者基本能耐受,不良事件发生率低,但活动级别仍局限于床上坐起,今后在临床推广早期活动过程中应进一步探索如何提高活动级别。 

The feasibility study of early mobilization for ICU patients in critical conditions

Objective To investigate the feasibility and efficacy of providing early physical activities for ICU patients and to serve as a reference for practicing early activities in ICU. Methods We sampled 32 patients who hospitalized in ICU for over 24 hours from August, 2014 to February, 2015.All patients met the standards for engaging in early physical activities, and they participated in a total of 81 early activities following standard protocols.Physical activity levels (a total of 4classes from sitting up in bed with nurses' assistance to autonomous walking) were gradually increased per patients' level of resilience and changes in vital signs.Pre and post vital functions including HR, RR, SpO₂, and BP were measured and compared.Patients' subjective feelings including dizziness, fatigue, and pain were recorded.Adverse events such as tumbling, slipping, and sudden worsening of symptoms were also observed. Results Among the 81 early activities (64 first class, 6 second class, 10 third class, 1 fourth class), patients reported positive feelings in 51 cases, moderate but tolerable discomfort in 26 cases, and intolerable experience in 4 cases.There was one case of thrombophlebitis, but no tumbling or slipping was observed.No statistical significant difference was found between pre-and post-activity HR, RR, SpO₂, or DBP measures (P > 0.05).There was a statistically significant increase in post-activity SBP (P < 0.01). Conclusion Following a standardized protocol, it is safe and feasible to provide early physical activities for ICU patients.Although the class of activity is mostly constrained to sitting up in bed, the protocol is tolerable for patients and free from adverse events.Further investigations on methods to improve class of activity are needed in future clinical practices on early activities.