渐进性活动与运动进阶训练对重症患者功能康复的影响：前瞻性随机对照研究

殷欣慰; 戴勇; 黄怀; 李新亚; 邢然然; 叶云霞; 钱绮雯

doi:10.16016/j.2097-0927.202203100

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渐进性活动与运动进阶训练对重症患者功能康复的影响：前瞻性随机对照研究

临床医学 | 更新时间：2026-01-09

- 渐进性活动与运动进阶训练对重症患者功能康复的影响：前瞻性随机对照研究
- Effect of progressive and step-up mobilization and exercise training on functional rehabilitation in critically ill patients: a prospective randomized controlled trail
- 陆军军医大学学报 2022年44卷第19期页码：1988-1995
- 作者机构：
  
  1.510006 广州，广州中医药大学研究生院
  2.510010 广州，中国人民解放军南部战区总医院康复科/重症康复中心
- 作者简介：
  
  [ 黄怀，E-mail：huanghuai1999@163.com HUANG Huai, E-mail: huanghuai1999@163.com
- 基金信息：
  
  军队后勤科研项目(CLB20J034)
- DOI：10.16016/j.2097-0927.202203100
  中图分类号： R181.32;R455;R493
- 收稿：2022-03-11，
  
  修回：2022-05-04，
  
  纸质出版：2022-10-15
- 稿件说明：
移动端阅览
殷欣慰, 戴勇, 黄怀, 等. 渐进性活动与运动进阶训练对重症患者功能康复的影响：前瞻性随机对照研究[J]. 陆军军医大学学报, 2022,44(19):1988-1995.

Xinwei YIN, Yong DAI, Huai HUANG, et al. Effect of progressive and step-up mobilization and exercise training on functional rehabilitation in critically ill patients: a prospective randomized controlled trail[J]. Journal of Army Medical University, 2022, 44(19): 1988-1995.
殷欣慰, 戴勇, 黄怀, 等. 渐进性活动与运动进阶训练对重症患者功能康复的影响：前瞻性随机对照研究[J]. 陆军军医大学学报, 2022,44(19):1988-1995. DOI： 10.16016/j.2097-0927.202203100.

Xinwei YIN, Yong DAI, Huai HUANG, et al. Effect of progressive and step-up mobilization and exercise training on functional rehabilitation in critically ill patients: a prospective randomized controlled trail[J]. Journal of Army Medical University, 2022, 44(19): 1988-1995. DOI： 10.16016/j.2097-0927.202203100.

摘要

目的

探讨渐进性活动与运动进阶训练对重症患者功能康复的影响。

方法

通过随机数字表法将2019年9月1日至2021年9月1日在南部战区总医院重症监护病房、高依赖病房就诊的60例重症患者分为观察组与对照组，每组30例。两组患者均给予常规救治和护理，在此基础上，对照组接受常规运动康复训练，观察组开展被动、辅助、主动3个阶段的渐进性活动与运动进阶训练，为期6周。在训练前和训练6周后通过Fug1-Meyer评定量表下肢部分(Fugl-Meyer Assessment of Lower Extremity，FMA-LE)评估患者运动功能，改良Barthel量表(Modified Barthel Index，MBI)评估患者日常生活活动能力；分别在训练前，训练的第2、4和6周，应用徒手肌力评估量表(Medical Research Council Scale，MRC)和床旁膈肌超声评估肌肉功能。

结果

训练2周后，两组患者的肌力和膈肌移动度与其训练前相比皆下降，其中，对照组的下降程度更甚(

0.05)；训练4周和6周后，两组患者肌力和膈肌移动度均得到改善(

0.05)，观察组患者改善更加明显(

0.05)；训练6周后，两组患者LE-FMA与MBI评分均较训练前提高(

0.05)，且观察组显著高于对照组(

0.05)。

结论

与常规运动康复训练方案相比，渐进性活动与运动进阶训练方案更能促进患者膈肌功能、上下肢肌力和下肢运动功能的康复，提高生活质量。

Abstract

Objective

To determine the effect of progressive and step-up mobilization and exercise training on functional rehabilitation in critically ill patients.

Methods

A total of 60 critically ill patients hospitalized in the Intensive Care Unit and High Dependence Unit of General Hospital of Southern Theater Command during September 1

2019 and September 1

2021 were prospectively recruited

and then randomly divided into observation group and control group

with 30 cases in each group. Both groups received routine treatment and nursing care. The patients of the control group received a conventional exercise rehabilitation training for 6 weeks

while those of the observation group underwent a 3-staged (passive

auxiliary

and active) progressive and step-up mobilization and exercise training for 6 weeks. Before and after the 6-week training

Fugl-Meyer Assessment of Lower Extremity (LE-FMA) was used to assess the motor function of the patient

and Modified Barthel Index (MBI) was used to assess their abilities for activities of daily living. Muscle function was assessed by Medical Research Council Scale (MRC) scale and bedside diaphragmatic ultrasonography before and at 2

and 6 weeks after training.

Results

After 2 weeks of training

the muscle strength and diaphragm excursion were decreased in both groups compared

and the decrease was more obvious in the control group (

0.05). After 4 and 6 weeks of training

the muscle strength and diaphragm excursion were improved in both groups (

0.05)

and the improvement was more significant in the observation group (

0.05). At the end of training

the scores of LE-FMA and MBI were improved in the 2 groups when compared with those before training (

0.05)

and the scores of the observation group were significantly higher than those of the control group (

0.05).

Conclusion

Compared with the conventional exercise rehabilitation training

our progressive and step-up mobilization and exercise training can more significantly promote patient's diaphragm function

upper and lower limb muscle strength and lower limb motor function

and thus improve the quality of life in critically ill patients.

关键词

Keywords

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