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早期活动缩短了腹部手术后重症监护病房患者的住院时间。

Early Ambulation Shortened the Length of Hospital Stay in ICU Patients after Abdominal Surgery.

作者信息

Amari Takashi, Matta Daiki, Makita Yukiho, Fukuda Kyosuke, Miyasaka Hiroki, Kimura Masami, Sakamoto Yuta, Shimo Satoshi, Yamaguchi Kenichiro

机构信息

Department of Rehabilitation, Health Science University, 7187 Kodachi, Fujikawaguchiko, Yamanashi 401-0380, Japan.

Department of Anatomy and Life Structure, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo 113-8421, Japan.

出版信息

Clin Pract. 2023 Dec 18;13(6):1612-1623. doi: 10.3390/clinpract13060141.

Abstract

The optimal time to ambulation remains unclear for intensive care unit (ICU) patients following abdominal surgery. While previous studies have explored various mobilization techniques, a direct comparison between ambulation and other early mobilization methods is lacking. Additionally, the impact of time to ambulation on complications and disuse syndrome prevention requires further investigation. This study aimed to identify the optimal time to ambulation for ICU patients after abdominal surgery and considered its potential influence on complications and disuse syndrome. We examined the relationship between time to ambulation and hospital length of stay (LOS). Patients were categorized into the nondelayed (discharge within the protocol time) and delayed (discharge later than expected) groups. Data regarding preoperative functioning, postoperative complications, and time to discharge were retrospectively collected and analyzed. Of the 274 postsurgical patients managed in the ICU at our hospital between 2018 and 2020, 188 were included. Time to ambulation was a significant prognostic factor for both groups, even after adjusting for operative time and complications. The area under the curve was 0.72, and the cutoff value for time to ambulation was 22 h (sensitivity, 68%; specificity, 77%). A correlation between time to ambulation and complications was observed, with both impacting the hospital LOS (model 1: < 0.01, r = 0.22; model 2: < 0.01, r = 0.29). Specific cutoff values for time to ambulation will contribute to better surgical protocols.

摘要

对于接受腹部手术后入住重症监护病房(ICU)的患者而言,最佳下床活动时间仍不明确。尽管先前的研究探索了各种活动技术,但缺乏对下床活动与其他早期活动方法的直接比较。此外,下床活动时间对并发症和废用综合征预防的影响还需要进一步研究。本研究旨在确定腹部手术后ICU患者的最佳下床活动时间,并考虑其对并发症和废用综合征的潜在影响。我们研究了下床活动时间与住院时间(LOS)之间的关系。患者被分为未延迟组(在方案规定时间内出院)和延迟组(出院时间晚于预期)。回顾性收集并分析了术前功能、术后并发症及出院时间等数据。在2018年至2020年期间,我院ICU收治的274例术后患者中,有188例被纳入研究。即使在调整手术时间和并发症因素后,下床活动时间仍是两组患者的重要预后因素。曲线下面积为0.72,下床活动时间的截断值为22小时(敏感性为68%;特异性为77%)。观察到下床活动时间与并发症之间存在相关性,二者均对住院时间有影响(模型1:<0.01,r = 0.22;模型2:<0.01,r = 0.29)。下床活动时间的特定截断值将有助于制定更好的手术方案。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/10e2/10742920/690172b8f3c0/clinpract-13-00141-g001.jpg

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