Physiological responses to the early mobilisation of the intubated, ventilated abdominal surgery patient
Physiological responses to the early mobilisation of the intubated, ventilated abdominal surgery patient
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DOI：
10.1016/s0004-9514(14)60101-x
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发表时间：
2004-01-01
影响因子：
--
通讯作者：
McCarren, B
中科院分区：
文献类型：
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作者：
Zafiropoulos, B;Alison, JA;McCarren, B
本研究的目的是调查在插管，通气腹部手术患者的呼吸和血液动力学变量的影响。活动定义为活动从仰卧到坐在床边、站立、原地行走1分钟、最初坐在床外和坐在床外20分钟的进展。17例患者的年龄（平均值+/- SD）为71.4 +/- 7.1岁，符合入选标准。在上述每个位置测量呼吸和血流动力学参数，并与仰卧位进行比较。在完成方案的15名受试者中，站立导致分钟通气量（V-E）从仰卧位的15.1 +/- 3.1 l/min显著增加至站立位的21.3 +/- 3.6 l/min（p < 0.001）。通过潮气量（V-T）从712.7 +/- 172.8 ml显著增加至883.4 +/- 196.3 ml（p = 0.008）和呼吸频率（f（R））从21.4 +/- 5.0次/min显著增加至24.9 +/- 4.5次/min（p = 0.03），实现了站立时V-E的增加。当活动进展到当场行走1分钟时，除了站立外，没有观察到这些参数进一步增加。当将仰卧位值与就地行走1分钟进行比较时，吸气流速（V-T/T-I）从683 +/- 131.8 ml/sec显著增加至985.1 +/- 162.3 ml/sec（p = 0.001），胸腔位移显著增加（p = 0.001），腹部位移无显著增加（p = 0.23）。活动后动脉血气未见改善。V-T、f（R）和V-E的变化主要是由于从仰卧位移动到站立位时的位置变化。
The aim of this study was to investigate the effects of mobilisation on respiratory and haemodynamic variables in the intubated, ventilated abdominal surgical patient. Mobilisation was defined as the progression of activity from supine, to sitting over the edge of the bed, standing, walking on the spot for one minute, sitting out of bed initially, and sitting out of bed for 20 minutes. Seventeen patients with age (mean +/- SD) 71.4 +/- 7.1 years satisfied inclusion criteria. Respiratory and haemodynamic parameters were measured in each of the above positions and compared with supine. In the 15 subjects who completed the protocol, standing resulted in significant increases in minute ventilation (V-E) from 15.1 +/- 3.1 l/min in supine to 21.3 +/- 3.6 l/min in standing (p < 0.001). The increase in V-E in standing was achieved by significant increases in tidal volume (V-T) from 712.7 +/- 172.8 ml to 883.4 +/- 196.3 ml (p = 0.008) and in respiratory rate (f(R)) from 21.4 +/- 5.0 breaths/min to 24.9 +/- 4.5 breaths/min (p = 0.03). No further increases were observed in these parameters beyond standing when activity was progressed to walking on the spot for one minute. When supine values were compared with walking on the spot for one minute, inspiratory flow rates (V-T/T-I) increased significantly from 683 +/- 131.8 ml/sec to 985.1 +/- 162.3 ml/sec (p = 0.001) with significant increases in rib cage displacement (p = 0.001) and no significant increase in abdominal displacement (p = 0.23). Arterial blood gases displayed no improvements following mobilisation. Changes in V-T, f(R), and V-E were largely due to positional changes when moving from supine to standing.