Department of Medicine, Pulmonary and Critical Care Division, Intermountain Medical Center, Murray, UT 84107, USA.
Am J Respir Crit Care Med. 2012 Dec 15;186(12):1220-8. doi: 10.1164/rccm.201206-1022CP. Epub 2012 Oct 11.
Critical illness and its treatment often result in long-term neuropsychiatric morbidities. Consequently, there is a need to focus on means to prevent or ameliorate these morbidities. Animal models provide important data regarding the neurobiological effects of physical activity, including angiogenesis, neurogenesis, and release of neurotrophic factors that enhance plasticity. Studies in noncritically ill patients demonstrate that exercise is associated with increased cerebral blood flow, neurogenesis, and brain volume, which are associated with improved cognition. Clinically, research in both healthy and diseased human subjects suggests that exercise improves neuropsychiatric outcomes. In the critical care setting, early physical rehabilitation and mobilization are safe and feasible, with demonstrated improvements in physical functional outcomes. Such activity may also reduce the duration of delirium in the intensive care unit (ICU) and improve neuropsychiatric outcomes, although data are limited. Barriers exist regarding implementing ICU rehabilitation in routine care, including use of sedatives and lack of awareness of post-ICU cognitive impairments. Further research is necessary to determine whether prior animal and human research, in conjunction with preliminary results from existing ICU studies, can translate into improvements for neuropsychiatric outcomes in critically ill patients. Studies are needed to evaluate biological mechanisms, risk factors, the role of pre-ICU functional level, and the timing, duration, and type of physical activity for optimal patient outcomes.
危重病及其治疗常常导致长期的神经精神并发症。因此，有必要关注预防或改善这些并发症的方法。动物模型提供了关于体力活动对神经生物学影响的重要数据，包括血管生成、神经发生和释放神经营养因子，这些都能增强可塑性。非危重病患者的研究表明，运动与增加脑血流、神经发生和脑容量有关，而这些又与认知功能的改善有关。临床上，对健康和患病人类受试者的研究表明，运动可改善神经精神结局。在重症监护病房（ICU）中，早期进行身体康复和活动是安全可行的，可改善身体功能结局。这种活动还可能减少 ICU 中谵妄的持续时间，并改善神经精神结局，尽管数据有限。在常规护理中实施 ICU 康复存在障碍，包括使用镇静剂和对 ICU 后认知障碍缺乏认识。需要进一步研究，以确定先前的动物和人类研究，以及现有 ICU 研究的初步结果，是否可以转化为改善危重病患者的神经精神结局。需要研究来评估生物学机制、危险因素、ICU 前功能水平的作用，以及最佳患者结局的身体活动的时间、持续时间和类型。
