不同频率踝泵运动对偏瘫患者下肢静脉血流影响的研究

Study on the Influence of Different Frequencies of Ankle Pump Exercise on Venous Hemodynamics of the Lower Extremity in Patients With Hemiplegia

目的探讨脑出血偏瘫患者最有效踝泵运动的频率和持续时间。方法选取2021年8月—2023年8月福州市第一总医院神经外科的30例脑出血偏瘫患者。分别给予下肢健侧(A组)和瘫侧(B组)的主被动踝泵运动,踝泵运动频率为3次/min、6次/min、15次/min、30次/min。干预后通过超声监测股静脉平均血流速度、运动结束股静脉平均血流速度恢复到基线时间及记录最有效频率主动踝泵运动的持续时间。结果A组在静息状态、3次/min、6次/min、15次/min、30次/min时股静脉平均血流速度分别为(16.83±1.84)、(18.09±2.05)、(21.19±3.80)、(25.83±3.21)、(28.87±2.74)cm/s;B组股静脉平均血流速度分别为(15.54±1.62)、(16.60±1.31)、(19.32±2.09)、(22.93±2.89)、(25.82±1.95)cm/s。A组和B组股静脉的平均血流速度均随频率的增加而增快,差异有统计学意义(P<0.001);相同频率踝泵运动A组股静脉平均血流速度快于B组,差异有统计学意义(P<0.05)。2组30次/min运动结束到股静脉平均血流速度恢复到基线时间长于3次/min、6次/min、15次/min,差异有统计学意义(P<0.01)。2组6次/min、15次/min的运动结束股静脉平均血流速度恢复到基线时间的差异有统计学意义(P<0.05)。当30次/min频率主动踝泵运动感到吃力,运动持续时间为172(158,199)s。结论不同频率的主被动踝泵运动均可提高脑出血偏瘫患者股静脉血流速度,促进下肢静脉血流回流,且快频率踝泵运动的效果更明显,以30次/min频率、持续3 min左右最佳。不同频率踝泵运动后瘫侧下肢静脉血流速度均低于健侧;因此更应尽早给予瘫侧被动踝泵运动。

Objective To explore the optimal frequency and duration of ankle pump exercise in patients with cerebral hemorrhage and hemiplegia.Methods A total of 30 patients with cerebral hemorrhage and hemiplegia were selected in department of neurosurgery,Fuzhou First General Hospital from August 2021 to August 2023.Active and passive ankle pump exercise was administered on the healthy side(group A)and paralyzed side(group B),respectively.Ultrasound was used to record the time-averaged mean velocity of femoral venous flow and the time from the end of the ankle pump exercise to the time-averaged mean velocity of femoral venous blood flow returns to the baseline when participants move at different frequencies of 3 times/min,6 times/min,15 times/min,30 times/min.The duration of active ankle pump exercise at the best frequency was recorded.Results The time-averaged mean velocity of femoral venous flow in the group A were(16.83±1.84),(18.09±2.05),(21.19±3.80),(25.83±3.21),(28.87±2.74)cm/s at rest,3 times/min,6 times/min,15 times/min,30 times/min,respectively.The time-averaged mean velocity of femoral venous flow in group B were(15.54±1.62),(16.60±1.31),(19.32±2.09),(22.93±2.89),(25.82±1.95)cm/s,respectively.The mean blood flow velocity of femoral vein in group A and group B increased with the increase of frequency,the difference was statistically significant(P<0.001).The average blood flow velocity of femoral vein in group A was faster than that in group B with the same frequency of ankle pump exercise,the difference was statistically significant(P<0.05).The average blood flow velocity of femoral vein from 30 times/min to baseline in 2 groups was longer than 3 times/min,6 times/min and 15 times/min,and the difference was statistically significant(P<0.01).The average blood flow velocity of femoral vein recovered to baseline after 6 times/min and 15 times/min between the two groups had statistical significance(P<0.05).When the ankle pump exercise was tired at 30 times/min,the duration of exercise was 172(158,199)seconds.Conclusion Active and passive ankle pump exercise with different frequencies can improve the femoral vein blood flow velocity and promote the venous blood return of the lower extremities in patients with hemiplegia after cerebral hemorrhage,fast frequency ankle pump exercise was more effective,the best effect was 30 times/min for 3 mins.After ankle pump exercise at different frequencies,the time-averaged mean velocity of the paralyzed side was lower than that of the healthy side.Therefore,passive ankle pump exercise on the paralyzed side should be given as soon as possible.