The Effect Of Early Active Mobilization On The Nutritional Status Of Critically Ill Patients

ObjectiveTo discuss whether early active mobilization can improve the nutritional index of the critical ill patients and reduce the malnutrition related outcomes and improve the prognosis of the patients.Methods 1.Group method: This is a prospective randomized controlled study.210 cases of critical ill patients admitted to our hospital from August 2016 to August 2017 were the subject investigated.We used a method of stratified random sampling to divide the patients into control group and test group.According to BMI,both of them were divided into 3 sub group.That were normal group(18.5<BMI<27.9)?malnutrition group(BMI?18.5)and obesity group(BMI?28).2.Intervention measures:The control group was given routine nursing and rehabilitation training.Test group was given to early active mobilization base on the control group,such as sitting in bed,do some active exercise in bed,sitting legs dangling,standing and walking exercise.3.Baseline data collection: We collect the names,sex,age,height,weight,body mass index,ADL score,APACHE II,muscle strength and vital signs as our baseline data.4.Outcome index: We measured the albumin,prealbumin,retinol binding protein,lymphocyte count,muscle strength when the patients were admitted to the ICU,admission for 3 days,7 days,and 14 days.At the same time we compared two groups of patients with nutritional status,muscle strength,mechanical ventilation time and the incidence of deep venous thrombosis,ICU hospitalization time.5.Statistical methods: To collect the data using SPSS19.0 software for statistical analysis,measurement data using t test,count data using X-test,all statistics were two-sided test,a =0.05 level test.Results 1.Baseline data: There was no significant difference between the test group and the control group in age,sex,ADL score,muscle strength and APACHE II score(P > 0.05).2.Nutritional indicators:(1)malnutrition(BMI ?18.5)group,the effect and time effect between groups were statistically significant and the interaction effect was not statistically significant.The difference of prealbumin,albumin and retinol binding protein at different time points was statistically significant.Further comparison between two groups showed that the prealbumin,albumin and retinol binding protein in the test group were higher than those in the control group,and the difference was statistically significant.Since the third day,the prealbumin was statistically significant in the test group and the control group.The retinol binding protein and albumin had statistical significance since the seventh day.(2)Normal nutrition group(BMI: 18.5<BMI<27.9),the effect between two groups was statistically significant,but time effect and interaction effect were not statistically significant.Further comparison between two groups showed that the prealbumin,albumin and retinol binding protein in the experimental group were higher than those in the control group,and the difference was statistically significant.Since the seventh day,the prealbumin was statistically significant in the test group and the control group.The retinol binding protein and albumin had statistical significance since the fourteenth day.(3)Obesity group(BMI ? 28),the effect between groups was statistically significant,but time effect and interaction effect were not statistically significant.Further comparison between two groups showed that only albumin in the trial group was significantly higher than that in the control group,and the difference was statistically significant.In the early stage of active activity,only albumin on the seventh day,the experimental group and the control group had statistical significance.3.Clinical outcome indicators: the time of mechanical ventilation,ICU hospitalization time and incidence of deep venous thrombosis in the test group were lower than those in the control group(P < 0.05).Repeated analysis of variance was used to analyze data at different time points between groups.ConclusionsEarly active mobilization for patients with malnutrition and normal nutritional status at admission can significantly improve the nutritional index and muscle strength of the patients and improve the nutritional status of the patients.Early active mobilization can significantly improve the incidence of hypoproteinemia in obese patients.Early active mobilization in critically ill patients can improve the muscle strength of the extremities,shorten the time of mechanical ventilation and ICU hospitalization,reduce the formation of deep venous thrombosis,and improve the prognosis and clinical outcome of the patients.