早期活动方案在颅内动脉瘤性蛛网膜下腔出血患者中的安全性和可行性。

Safety and feasibility of an early mobilization program for patients with aneurysmal subarachnoid hemorrhage.

机构信息

Department of Rehabilitation, Capital Health, 750 Brunswick Ave, Trenton, NJ 08638, USA.

出版信息

Phys Ther. 2013 Feb;93(2):208-15. doi: 10.2522/ptj.20110334. Epub 2012 May 31.

DOI:10.2522/ptj.20110334

PMID:22652987

Abstract

BACKGROUND

Survivors of aneurysmal subarachnoid hemorrhage (SAH) are faced with a complicated recovery, which typically includes surgery, prolonged monitoring in the intensive care unit, and treatment focusing on the prevention of complications.

OBJECTIVE

The purpose of this study was to determine the safety and feasibility of an early mobilization program for patients with aneurysmal SAH.

DESIGN

This study was a retrospective analysis.

METHODS

Twenty-five patients received early mobilization by a physical therapist or an occupational therapist, or both, which focused on functional training and therapeutic exercise in more progressively upright positions. Participation criteria focused on neurologic and physiologic stability prior to the initiation of early mobilization program sessions.

RESULTS

Patients met the criteria for participation in 86.1% of the early mobilization program sessions attempted. Patients did not meet criteria for the following reasons: Lindegaard ratio >3.0 or middle cerebral artery (MCA) mean flow velocity (MFV) >120 cm/s (8.1%), mean arterial pressure (MAP) <80 mm Hg (1.8%), intracranial pressure (ICP) >15 mm Hg (1.8%), unable to open eyes in response to voice (0.9%), respiratory rate >40 breaths/min (0.6%), MAP >110 mm Hg (0.3%), and heart rate <40 bpm (0.3%). Adverse events occurred in 5.9% of early mobilization program sessions for the following reasons: MAP <70 mm Hg (3.1%) or >120 mm Hg (2.4%) and heart rate >130 bpm (0.3%). The 30-day mortality rate for all patients was 0%. Participation in the early mobilization program began a mean of 3.2 days (SD=1.3) after aneurysmal SAH, and patients received an average of 11.4 sessions (SD=4.3). Patients required a mean of 5.4 days (SD=4.2) to participate in out-of-bed activity and a mean of 10.7 days (SD=6.2) to walk ≥15.24 m (50 ft).

CONCLUSIONS

The results of this study suggest that an early mobilization program for patients with aneurysmal SAH is safe and feasible.

摘要

背景

蛛网膜下腔出血（SAH）幸存者面临着复杂的康复过程，通常包括手术、在重症监护病房长时间监测以及预防并发症的治疗。

目的

本研究旨在确定早期动员计划对动脉瘤性蛛网膜下腔出血患者的安全性和可行性。

设计

本研究为回顾性分析。

方法

25 名患者接受了物理治疗师或职业治疗师或两者的早期动员，重点是功能训练和更逐渐直立的位置上的治疗运动。参与标准侧重于早期动员计划开始前神经和生理稳定性。

结果

患者在尝试的 86.1%的早期动员计划中符合参与标准。患者不符合标准的原因如下：林德加德比率>3.0 或大脑中动脉（MCA）平均流速（MFV）>120cm/s（8.1%）、平均动脉压（MAP）<80mmHg（1.8%）、颅内压（ICP）>15mmHg（1.8%）、无法对声音做出睁眼反应（0.9%）、呼吸频率>40 次/分钟（0.6%）、MAP>110mmHg（0.3%）和心率<40bpm（0.3%）。早期动员计划中发生 5.9%的不良事件，原因如下：MAP<70mmHg（3.1%）或>120mmHg（2.4%）和心率>130bpm（0.3%）。所有患者的 30 天死亡率为 0%。早期动员计划的参与平均在蛛网膜下腔出血后 3.2 天（SD=1.3）开始，患者平均接受 11.4 次治疗（SD=4.3）。患者需要平均 5.4 天（SD=4.2）才能进行离床活动，需要平均 10.7 天（SD=6.2）才能行走≥15.24m（50 英尺）。