Rocca A, Pignat J-M, Berney L, Jöhr J, Van de Ville D, Daniel R T, Levivier M, Hirt L, Luft A R, Grouzmann E, Diserens K
Department of Clinical Neurosciences, Neurosurgery Unit, University Hospital CHUV, Rue du Bugnon 46, 1011, Lausanne, Switzerland.
Department of Clinical Neurosciences, Acute Neurorehabilitation Unit, University Hospital CHUV, Lausanne, Switzerland.
BMC Neurol. 2016 Sep 13;16(1):169. doi: 10.1186/s12883-016-0684-2.
Patients who experience severe brain injuries are at risk of secondary brain damage, because of delayed vasospasm and edema. Traditionally, many of these patients are kept on prolonged bed rest in order to maintain adequate cerebral blood flow, especially in the case of subarachnoid hemorrhage. On the other hand, prolonged bed rest carries important morbidity. There may be a clinical benefit in early mobilization and our hypothesis is that early gradual mobilization is safe in these patients. The aim of this study was to observe and quantify the changes in sympathetic activity, mainly related to stress, and blood pressure in gradual postural changes by the verticalization robot (Erigo®) and after training by a lower body ergometer (MOTOmed-letto®), after prolonged bed rest of minimum 7 days.
Thirty patients with severe neurological injuries were randomized into 3 groups with different protocols of mobilization: Standard, MOTOmed-letto® or Erigo® protocol. We measured plasma catecholamines, metanephrines and blood pressure before, during and after mobilization.
Blood pressure does not show any significant difference between the 3 groups. The analysis of the catecholamines suggests a significant increase in catecholamine production during Standard mobilization with physiotherapists and with MOTOmed-letto® and no changes with Erigo®.
This preliminary prospective randomized study shows that the mobilization of patients with severe brain injuries by means of Erigo® does not increase the production of catecholamines. It means that Erigo® is a well-tolerated method of mobilization and can be considered a safe system of early mobilization of these patients. Further studies are required to validate our conclusions.
The study was registered in the ISRCTN registry with the trial registration number ISRCTN56402432 . Date of registration: 08.03.2016. Retrospectively registered.
经历严重脑损伤的患者存在继发性脑损伤风险，这是由延迟性血管痉挛和水肿所致。传统上，为维持充足的脑血流量，尤其是在蛛网膜下腔出血的情况下，许多此类患者需长期卧床休息。另一方面，长期卧床休息会带来严重的发病风险。早期活动可能具有临床益处，我们的假设是早期逐渐活动对这些患者是安全的。本研究的目的是观察并量化在至少7天的长期卧床休息后，通过垂直化机器人（Erigo®）进行逐渐体位改变以及在使用下肢测力计（MOTOmed-letto®）训练后，主要与应激相关的交感神经活动和血压的变化。
30例严重神经损伤患者被随机分为3组，采用不同的活动方案：标准方案、MOTOmed-letto®方案或Erigo®方案。我们在活动前、活动期间和活动后测量血浆儿茶酚胺、甲氧基肾上腺素和血压。
3组之间血压无显著差异。儿茶酚胺分析表明，在由物理治疗师进行标准活动以及使用MOTOmed-letto®时，儿茶酚胺分泌显著增加，而使用Erigo®时无变化。
这项初步的前瞻性随机研究表明，使用Erigo®对严重脑损伤患者进行活动不会增加儿茶酚胺的分泌。这意味着Erigo®是一种耐受性良好的活动方法，可被视为这些患者早期活动的安全系统。需要进一步研究来验证我们的结论。
该研究在ISRCTN注册中心注册，试验注册号为ISRCTN56402432。注册日期：2016年3月8日。回顾性注册。
