| Objective: To investigate the effects of early mobilization on relevant coagulation indicators and the blood flow velocity of lower extremity deep vein with adult patients in intensive care unit,and analyse the results of early mobilization on prevention lower extremity deep vein thrombosis and intensive care unit-acquired weakness.According to the characteristics of intensive care unit adult patients complicated,environmental restrictions,and making safety,feasibility and effective of early mobilization implementation process in hospital bed,providing the theory and practice of early mobilization in intensive care unit in the future.Methods: This research adopted the quasi-experiment research.From September 2016 to June 2017,a total in the standard of 87 adult patients of Second Area of intensive care unit(surgical intensive care unit,SICU)in the first affiliated hospital of guangxi medical university were selected by using convenient sampling and were assigned into a control group and an intervention group according to chronological order.And 44 cases of patients from October 2016 to January 2017 were assigned into the control group and 43 cases of patients from February 2017 to June 2017 to assigned into the intervention group.The control group were given the surgical intensive care unit routine nursing,while on the basis of the surgical intensive care unit routine nursing routine nursing,the intervention group received early mobilization after 24 hours of admission to the surgical intensive care uint.The steps including disease assessment,the plan of early mobilization implementation,security and records.The two groups of patients were collected general information,relevant coagulation indicators,the blood flow velocity of lower limbs femoral vein and popliteal vein by the color doppler ultrasound examination,the Medical Research Council scores(MRC-score)and so on within 24 hours of admission to the surgical intensive care uint.The two groups of patients were collected again relevant coagulation indicators,the blood flow velocity of lower limbs femoral vein and popliteal vein,the duration of mechanical ventilation and length of stay in intensive care uint before they tranfer out intensive care uint(within 24 hours).The intervention group of patients were recorded the vital signs changes and mileage before and after doing exercise of in bed cycling,and adverse security events with early mobilization.We analyzed and processed the date by using SPSS22.0 statistical software,with P < 0.05 was considered statistically significant.Results:1.Camparison of the general demographic and clinical data between two groups of patients:Two groups of patients in age,gender,Body mass index,24 hours of acute physiology and chronic health evaluation,the types of diseases such as baseline data were not statistically significance(P>0.05),with comparability.2.Camparison of the relvant coagulation indicators in the two groups of patients with ICU:(1)within 24 hours of admission to ICU,the D-dimer level and platelet counts were no significant statistical differences between the two groups(P>0.05),with comparability;After early mobilization,the D-dimer level changes in the intervention group was significantly lower than that in the control group,the difference was statistically significant(P<0.05).And the platelet count between intervention group and control group,the difference was no statistically significant(P>0.05).(2)within 24 hours of admission to ICU,Four Coagulation indicators of APTT,PT,FIB,TT were no significant differences between the two groups within 24 hours of admission to ICU(P>0.05).Before tranfer out ICU,the coagulation indicators of APTT,PT and TT between intervention group and control group,the difference were no statistical significance(P>0.05).But before tranfer out ICU,the coagulation indicators of FIB of intervention group significantly lower than that in control group,the difference was statistically significant(P<0.05).3.Comparion of the blood flow velocity of femoral vein and popliteal vein between two groups of patients: within 24 hours of admission to ICU,the blood flow velocity of femoral vein and popliteal vein that in two groups of patients were no statistically significant difference(P>0.05).Before tranfer out ICU,the blood flow velocity of femoral vein and popliteal vein of intervention group were significantly higher than that in control group,the difference were statistically significant(P<0.05).4.Comparion of the incidence of lower extremity DVT between two groups of patients: In this research,the incidence of lower extremity DVT of control group was 6.8 percent,and intervention group was 2.3 percent,there was no statistically significant difference comparing the two group(Fisher's exact probability method,P=0.625).5.Comparion of the MRC score between two groups of patients:(1)within 24 hours of admission to ICU,the MRC score that in two groups of patients was no statistically significant difference(P>0.05).(2)Before tranfer out ICU,the MRC score of intervention group was significant higher than that in control group,the difference was statistically significant(P<0.05).While before tranfer out ICU,the MRC score of control group was significantly lower than within 24 hours of admission to ICU,the difference was statistically significant(P<0.05).Before tranfer out ICU,the MRC score of intervention group was significantly higher than within 24 hours of admission to ICU,the difference was statistically significant(P<0.05).6.Comparion of the incidence of ICU-acquired weakness between two groups of patients: the incidence of ICU-acquired weakness of intervention group was significantly lower than that in control group,the difference was statistically significant(P<0.05).7.Comparion of the duration of mechanical ventilation and length of saty in ICU between two groups of patients: the duration of mechanical ventilation and length of saty in ICU of intervention group were(4.19±1.86)days and(8.75± 3.39)days respectively,and that in control group were(5.00±1.29)days and(10.26±3.63)days respectively,the duration of mechanical ventilation and length of saty in ICU of intervention group were significantly shorter than that in control group,the difference was statistically significant(P<0.05).8.The changes of vital signs and mileage before and after in bed cycling exercise and the implementation of early mobilization intervention of adverse security events:(1)The vital signs of heart rate,systolic blood pressure,saturation of pluse oxygen in bed cycling exercise before and after of 43 patients,there were no statistically significant difference(P>0.05).But after in bed cycling exercise,the diastolic blood pressure of 43 patients were higher than that before exercise,the difference was statistically significant(P<0.05).(3)The mileage of descriptive analysis of in bed cycling exercise of 43 patients showed that the mileage range of 2650 ~ 6654,and the average mileage range of(4008.93± 1296.29).(3)There are 2 patients with oxygen desaturation to 85 percent and 90 percent in 1 case respectively of in bed cycling exercise process,and stopped exercise immediately,the saturation of pluse oxygen of patients came to normal when increasing flow rate,in the next time the speed of in bed cycling exercise was reduced.In 1 case of 1 patient,when the speed was biggest in bed cycling exercise,the heart rate of patient up to 130 times per minute,stopped and rested immediately,and patient restored a normal heart rate.There were no pipe fall off,deliberate slef-extubation,fall down,and worsening condition such as adverse security events.Conclusions:1.ICU patients affected by multiple factors,in a relatively high blood coagulation state,the patients with early mobilization intervention may reduce blood high condensation state.2.ICU patients is relatively high blood coagulation state,and the blood flow velocity of femoral vein and popliteal vein were affected,but early mobilization can accelerate the blood flow velocity of femoral vein and popliteal vein with ICU patients.3.The muscle strength of patients in the ICU have weakness as time goes by,patients with early mobilization to maintain muscle strength,restores the physical strength and prevention on muscle atrophy.4.Early mobilization can shorten the duration of mechanical ventilation and length of saty in ICUwith patients.5.With the doctors and nurses sufficiency of assessment,it is safety and feasible with early mobilization for ICU patients. |
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