Effect of progressive early bed exercise on blood flow in lower limb of patients on mechanical ventilation in intensive care unit / 中华危重病急救医学

Objective To investigate the effect of progressive early bed physical activity on blood flow in lower limb of patients on mechanical ventilation in intensive care unit (ICU). Methods Adult patients with mechanical ventilation ≥ 72 hours admitted to ICU of the Affiliated Hospital of Zunyi Medical University from February 22nd to November 30th, 2016 were enrolled. The patients were randomly divided into experimental group and control group by random number table method. Patients in the two groups were given the same basic treatment, including antibiotics, analgesia and sedation, mechanical ventilation, nutritional support, and routine ICU activities such as maintaining functional position of limbs and raising of bed head. On the basis of those, the experimental group was given early bed physical activity with gradual enhancement of grades Ⅰ-Ⅲ according to the nerve, circulation and respiration situations, such as passive/active exercise of the bicycle, straight leg lifting exercise, etc. The exercise intensity was evaluated with target heart rate, and the exercise was performed for 15-30 minutes at a time, twice a day. The control group was given intermittent pneumatic compression (IPC), 30 minutes in each time, twice a day. Mean blood flow and blood volume were measured before and immediately, 5, 10 and 15 minutes after intervention on the 3rd day. Heart rate and blood pressure were measured at 5 minutes before intervention, during 5 minutes, and 5, 10, 15, 30 minutes after intervention on the 3rd day. Results 214 adult patients were selected, after excluding the patients who died during the intervention or gave up treatment, 160 patients were included in the data analysis, with 81 in the experimental group and 79 in the control group. The mean blood flow velocity and blood volume were increased in both groups, and the mean blood flow velocity and blood flow volume in the experimental group were significantly increased and lasted longer than those in the control group [mean blood flow velocity (mm/s) of the experimental group were 11.92±1.06, 18.19±0.17, 17.24±0.14, 15.48±0.12, 12.68±0.16, and that of the control group were 12.01±1.41, 15.65±0.18, 12.91±0.14, 12.13±0.12, 11.59±0.16, respectively, the time effect was F = 1 043.101, P = 0.000, the intervention effect was F = 151.001, P = 0.000, and the interaction effect between intervention and time was F = 224.830, P = 0.001; the blood volume (mL/min) of the experimental group were 3.39±0.96, 5.59±0.11, 5.16±0.12, 4.19±0.10. 3.35±0.09, and that of the control group were 3.28±0.82, 4.04±0.11, 3.40±0.12, 3.02±0.10, 3.00±0.10, respectively, the time effect was F = 680.405, P = 0.000, the intervention effect was F = 125.359, P = 0.000, and the interaction effect between intervention and time was F = 79.631, P = 0.012]. The heart rate and blood pressure of the two groups of patients in the course of intervention were increased first, then decreased and then slowly recovered to the change trend before intervention, but the index of the experimental group fluctuated greatly [heart rate (bpm) of the experimental group were 97.64±1.50, 113.91±1.36, 105.96±1.34, 98.52±1.48, 97.84±1.46, 97.54±1.48, and that of the control group were 97.03±1.57, 105.39±1.38, 96.76±1.35, 96.54±1.50, 97.22±1.48, 96.53±1.49, respectively, the time effect was F = 235.030, P = 0.000, the intervention effect was F = 39.473, P = 0.000, and the interaction effect between intervention and time was F = 3.494, P = 0.063; the systolic blood pressure (mmHg, 1 mmHg = 0.133 kPa) of the experimental group were 118.57±1.06, 133.05±1.01, 120.44±1.10, 117.78±1.07, 117.65±1.01, 118.14±1.00, and that of the control group were 118.10±1.08, 126.68±1.02, 118.23±1.11, 117.48±1.08, 118.04±1.03, 118.90±1.10, respectively, the time effect was F = 336.604, P = 0.000, the intervention effect was F = 26.350, P = 0.000, and the interaction effect between intervention and time was F = 0.948, P = 0.332; the diastolic blood pressure (mmHg) of the experimental group were 68.07±0.72, 72.79±0.73, 70.68±0.74, 69.30±0.72, 68.73±0.74, 67.80±0.73, and that of the control group were 68.51±0.73, 72.03±0.74, 70.05±0.75, 69.10±0.73, 68.41±0.75, 67.85±0.74, respectively, the time effect was F = 286.390, P = 0.000, the intervention effect was F = 4.812, P = 0.000, and the interactive effect between intervention and time was F = 0.055, P = 0.815]. Conclusions The effects of progressive early bed physical activity on the mean blood flow velocity and blood volume of lower limbs in ICU patients with mechanical ventilation are better than those of IPC. Although the fluctuation of heart rate and blood pressure is large, it does not cause any harm to the patients.

Application of walking combined with Buerger exercise in patients with grade 0 diabetic foot / 中国基层医药

Objective To study the application of walking combined with Buerger exercise in the treatment of grade 0 diabetic foot.Methods Eighty patients with grade 0 diabetic foot were randomly divided into observation group and control group.The control group was trained by walking exercise .The observation group was trained by walking combined with Buerger exercise through 12 months of training.The changes of self-sensory symptoms,ABI and DAWV were observed.Results The self-sensory symptoms of the two groups were significantly decreased (observation group: markedly effective 15 cases,effective 19 cases;control group: markedly effective 5 cases,effective 23 cases).The effective rate of the observation group was higher than that of the control group (85% vs.70%,χ2 =7.831,P <0.05).The ABI ratio of the two groups were higher than those before treatment ,and the ABI ratio of the observation group was higher than that of the control group [(0.889 ±0.113) vs.(0.842 ±0.124),t =1.772 P <0.05].The ratio of DAWV in the observation group was higher than that in the control group [(6.772 ±0.435)cm/s vs.(6.543 ±0.552)cm/s,t =2.061,P <0.05].Conclusion Walking combined with Buerger exercise can improve the blood flow velocity and blood flow of the collateral circulation of the lower limbs of patients with grade 0 diabetic foot,and improve the self-sensory symptoms of peripheral neuropathy .

Cerebral Hemodynamic Evaluation of Diabetes Mellitus by Transcranial Doppler Sonography

OBJECTIVE: The purpose of this study was to evaluate hemodynamics for diabetes mellitus (DM) by transcranial Doppler sonography (TCD) and to evaluate the influences of risk factors to cerebral hemodynamics in DM. METHOD: We examined 54 normal persons, 17 patients with DM without risk factors, and 15 patients with DM and risk factors. The risk factors were hypertension, smoking, and hyper lipidemia (total cholesterol >240 mg/dl, low density lipoprotein >160 mg/dl). Mean blood flow velocity (MBFV) was also analyzed by Angiodine 2 Doppler system operating at 2 MHz frequency from each subjects. RESULTS: There was a significant decrease of MBFV in the diabetes in comparison to control groups (p<0.05). There was a significant decrease of MBFV in the diabetic risk group as compared to diabetic non-risk group (p<0.05). There was significantly increased total cholesterol, low density lipoprotein, low density lipoprotein/high density lipoprotein ratio in the diabetic risk group as compared to diabetic non-risk group (p<0.05). MBFV significantly decreased with increasing concentration of HbA1C and duration of DM (p<0.05). CONCLUSION: We suggest that transcranial Doppler sonography can be used as one of the useful screening tests for early detection of cerebrovascular diseases in DM.

Assessment of Cerebral Hemodynamics Using Transcranial Doppler Sonography in Normal Adults

OBJECTIVE: To establish the normal values of the transcranial doppler sonography in healthy Korean adults according to the increasing age and sex. METHOD: We examined 68 healthy adult volunteers who had no history of diabetes mellitus, hypertension, cerebrovascular disease or other neurological illness. The study included 54 subjects from whom good doppler signals from the middle, anterior, and posterior cerebral arteries could be obtained. Mean blood flow velocity (MBFV), Resistance index (RI), and Pulsatility index (PI) were analyzed by Angiodine 2 Doppler System operating at 2 MHz frequency. RESULTS: MBFV significantly decreased with the increasing age in the middle, anterior and posterior cerebral arteries (p0.05). There was no significant difference in the RI and PI between the male and female subjects. CONCLUSION: We suggest that the transcranial doppler sonography can be used as one of the useful screening tools for the diagnosis of cerebrovascular diseases.

Changes of Cerebral Blood Flow Velocity in Different End Tidal Carbon Dioxide Tension during Enflurane-N2O-O2 Anesthesia / 대한마취과학회지

The changes of cerebral blood flow velocity, pulsatility index and resistance index were studied during Enflurane-N2O-O2 anesthesia according to the change of end tidal carbon dioxide tension in 14 gynecologic surgical patients. From the both middle cerebral artery, mean blood flow velocity, resistance index and pulsatility index were checked with transcranial doppler before anesthesia with room air respiration and during anesthesia with controlled ventilation. The anesthesia was controlled with 2.0+/-0.5% Enflurane and 3 liter/min. of nitrous oxide and 2 liter/min. of oxygen. The end tidal CO2 tension was controlled by change of respiratory rate and tidal volume from 30 mmHg to 40 mmHg during anesthesia. Mean blood flow velocity, resistance index, and pulsatility index of middle cerebral artery were compared between unanesthetized room air respirated patient and anesthetized patient. The result were as follows : 1. There were no differences of systolic, diastolic, mean blood flow velocity, resistance index and pulsatility index between right and left middle cerebral artery. 2. The mean blood flow velocity was significantly increased but the pulsatility index and resistance index was decreased during anesthesia compare to preanesthetic values. This may be due to the effect of anesthetics. 3. During steady state of anesthesia the mean blood flow velacity was increased and the pulsatility index and resistance index was decreased according to the change of ETCO2 With this result we can say the effect of carbon dioxide tension to the cerebral blood flow velocity was maintained during Enflurane-N2O-O2 anesthesia, but the flow was also affected by the anesthetics itself.

The Effect of Stellate Ganglion Block on Mean Blood Flow Velocity and Carbon Dioxide Reactivity of the Middle Cerebral Artery / 대한마취과학회지

We studied the effect of stellate ganglion block on the mean blood flow velocity and carbon diaxide reactivity of the middle cerehral artery in nine healthy volunteers. Mean blood flow velocity of the right middle cerebral artery was measured under normocapnia and carbon dioxide reactivity to end-tidal PCO2 of 30 mmHg, 40 mmHg, and 50 mmHg was assessed before and after right stellate ganglion block. End-tidal PCO2 was controlled by hyperventilation and rebthing technique. Mean blood flow velocity was measured using transcranial Doppler sonography, and carbon dioxide reactivity was expressed as the percentage change in mean blood flow velocity per unit change in end-tidal PCO2. There was no difference in mean blood flow velocity under normocapnia (37.7+/-1.1 mmHg) between the values measured before stellate ganglion block (60.3+/-4.9 cm/sec) and the values measured after stellate ganglion block (58.6+/-4.9 cm). Mean blood flow velocity increased as end-tidal PCO2 increased from 30 mmHg to 40 mmHg, and from 40 mmHg to 50 mmHg (p<0.01) both before and after stellate ganglion block. Carbon dioxide reactivity of mean blood flow velocity did not change after stellate ganglion block. Heart rate decreased from 77.1+/-3.5 beats/min to 70+/-2.5 beats/min when end-tidal PCO2 was controlled from 30 mmHg to 40 mmHg after stellate ganglion block (p<0.05). Mean arterial blood pressure did not change after stellate ganglion block at any end-tidal PCO2 level. These results suggest that stellate ganglion block does not induce the change of mean blood flow velocity and carbon dioxide reactivity of the middle cerebral artery.