改良式踝泵运动在脑卒中患者中的应用研究

doi:10.3761/j.issn.0254-1769.2025.09.007

摘要/Abstract

摘要：

目的探讨基于血流动力学机制的改良式踝泵运动对脑卒中患者静脉血栓预防的影响。方法采用便利抽样法，选取2023年6月—2024年6月江苏省南京市某三级甲等医院的110例脑卒中患者作为研究对象，试验组与对照组各纳入55例患者。试验组采用基于血流动力学机制的改良式踝泵运动护理干预，对照组采用常规护理干预，两组均干预至出院。比较两组住院第7天下肢深静脉血栓发生率和不同时间点匹兹堡康复参与量表、主观感觉劳累程度、运动自我效能得分的差异。结果两组研究对象未出现脱落。试验组下肢深静脉血栓发生率低于对照组（P=0.004）。试验组第1、3、5、7天匹兹堡康复参与量表得分均高于对照组（P<0.001），两组匹兹堡康复参与量表得分随时间变化趋势明显（P=0.034）。两组不同时间点的主观感觉劳累程度比较，差异有统计学意义（P<0.001）。两组运动自我效能随时间变化均有升高趋势（P=0.016），出院前1天试验组运动自我效能高于对照组（P=0.003）。结论实施基于血流动力学机制的改良式踝泵运动能有效降低脑卒中患者深静脉血栓发生率、提高患者匹兹堡康复参与度和运动自我效能，且不会增加主观感觉劳累程度。

关键词: 踝泵运动, 超声检查, 多普勒, 脑卒中, 静脉血栓预防, 护理

Abstract:

Objective To investigate the effect of ankle pump exercises，based on hemodynamic mechanisms，on the prevention of venous thrombosis in stroke patients. Methods A total of 110 stroke patients，admitted to a tertiary A hospital in Jiangsu Province between June 2023 and June 2024，were selected using a convenience sampling method. The patients were divided into an experimental group and a control group，with 55 patients in each group. The experimental group received ankle pump exercise nursing interventions based on hemodynamic mechanisms，while the control group received routine nursing interventions. The incidence of lower extremity deep vein thrombosis，Pittsburgh Rehabilitation Participation Scale scores，subjective perceived fatigue，and exercise self-efficacy scores were compared between 2 groups on the 7th day of hospitalization. Results No dropouts occurred in either group. The incidence of deep vein thrombosis was significantly lower in the experimental group than it in the control group（P=0.004）. The Pittsburgh Rehabilitation Participation scores on day 1，3，5，and 7 were higher in the experimental group compared to them in the control group（P<0.001）. A significant time-dependent trend was observed in Pittsburgh Rehabilitation Participation scores（P=0.034）. Subjective fatigue was significantly lower in the experimental group at various time points（P<0.001）. Both groups showed an increase in exercise self-efficacy over time（P=0.016），with the experimental group demonstrating higher exercise self-efficacy than the control group on the day before discharge（P=0.003）. Conclusion Ankle pump exercises，based on hemodynamic mechanisms，can effectively reduce the incidence of deep vein thrombosis in stroke patients，enhance rehabilitation participation and exercise self-efficacy，without increasing subjective fatigue.

Key words: Ankle Pump Exercise, Ultrasonography, Doppler, Stroke, Venous Thrombosis Prevention, Nursing Care

曹云, 孙国珍, 陈凤, 季学丽, 闫梦婉, 敬雷, 钱堃. 改良式踝泵运动在脑卒中患者中的应用研究[J]. 中华护理杂志, 2025, 60(9): 1068-1074.

CAO Yun, SUN Guozhen, CHEN Feng, JI Xueli, YAN Mengwan, JING Lei, QIAN Kun. A study of modified ankle pump exercise in stroke patients[J]. Chinese Journal of Nursing, 2025, 60(9): 1068-1074.

图/表 4

表1 两组一般资料的比较

Table 1 General information of pediatric patients in 2 groups

表2 两组血栓发生部位（例）

Table 2 Site of thrombosis in both groups（cases）

表3 两组不同时间点匹兹堡康复参与度、主观感觉疲劳程度比较（分，$\bar{x} \pm s$）

Table 3 Comparison of the Pittsburgh Rehabilitation Participation Scale，the degree of subjective perceived exertion at each time point between the 2 groups of patients（scores，$\bar{x} \pm s$）

表4 两组不同时间点运动自我效能得分比较（分，$\bar{x} \pm s$）

Table 4 Comparison of exercise self-efficacy scores at each time point between the 2 groups of patients（scores，$\bar{x} \pm s$）

参考文献 24

[1]	国家卫生健康委办公厅. 2024年国家医疗质量安全改进目标的通知[EB/OL]. (2024-02-01)[2024-10-18]. https://www.gov.cn/zhengce/zhengceku/202402/content_6929763.htm.
	General Office of the National Health Commission. Notice of the national medical quality and safety improvement target in 2024[EB/OL]. (2024-02-01)[2024-10-18]. https://www.gov.cn/zhengce/zhengceku/202402/content_6929763.htm.
[2]	Li TH, Yang SH, Hu F, et al. Effects of ankle pump exercise frequency on venous hemodynamics of the lower limb[J]. Clin Hemorheol Microcirc, 2020, 76(1):111-120.
[3]	胡蛟, 卜平元, 李玲, 等. 成人烧伤患者静脉血栓栓塞症预防的证据总结[J]. 中华护理杂志, 2023, 58(11):1381-1389. DOI
	Hu J, Bu PY, Li L, et al. Evidence summary for prevention of venous thromboembolism in adult burn patients[J]. Chin J Nurs, 2023, 58(11):1381-1389. DOI
[4]	陈敬芳, 王晓燕, 李旺. 足踝部定量活动仪辅助踝泵运动对骨科患者术后疼痛及股静脉血液回流的影响[J]. 护理学报, 2018, 25(4):1-4.
	Chen JF, Wang XY, Li W. Effectiveness of ankle pump movement aided by ankle quantitative activity instrument on pain and venous backflow of lower extremities after orthopedics surgery[J]. J Nurs(China), 2018, 25(4):1-4.
[5]	吴怡雯, 李敏, 王海尔, 等. 高龄患者主动和被动踝泵运动量化管理的效果分析[J]. 护理学杂志, 2023, 38(13):89-92.
	Wu YW, Li M, Wang HE, et al. Effect of quantitative management of active and passive ankle pump exercise in elderly patients[J]. J Nurs Sci, 2023, 38(13):89-92.
[6]	翟雅雅, 李淑敏, 程领. 踝泵运动联合呼吸功能锻炼预防肺腺癌患者围手术期静脉血栓栓塞症的效果[J]. 癌症进展, 2022, 20(5):525-528.
	Zhai YY, Li SM, Cheng L. Effect of ankle pump exercise combined with respiratory function exercise on prevention of perioperative venous thromboembolism in patients with lung adenocarcinoma[J]. Oncol Prog, 2022, 20(5):525-528.
[7]	中华医学会神经病学分会, 中华医学会神经病学分会脑血管病学组. 中国各类主要脑血管病诊断要点2019[J]. 中华神经科杂志, 2019, 52(9):710-715.
	Chinese Society of Neurology of Chinese Medical Association,Cerebrovascular Disease Group of Chinese Society of Neurology of Chinese Medical Association. Diagnostic criteria of cerebrovascular diseases in China(version 2019)[J]. Chin J Neurol, 2019, 52(9):710-715.
[8]	刘婷, 赵顺莹, 王灵聪, 等. 脑出血患者静脉血栓栓塞机械预防的证据总结[J]. 中华护理杂志, 2019, 54(6):935-939. DOI
	Liu T, Zhao SY, Wang LC, et al. Evidence summary for mechanical prophylaxis of venous thromboembolism in patients with intracerebral hemorrhage[J]. Chin J Nurs, 2019, 54(6):935-939. DOI
[9]	Yamada SM, Tomita Y, Murakami H, et al. Deep vein thrombosis in the lower extremities in comatose elderly patients with acute neurological diseases[J]. Yonsei Med J, 2016, 57(2):388-392. DOI PMID
[10]	曹云, 郝卫文, 敬雷, 等. 踝关节运动对健康成年人股静脉血流动力学及下肢疲劳程度的影响[J]. 中华现代护理杂志, 2023, 29(4):488-492.
	Cao Y, Hao WW, Jing L, et al. Effects of ankle pump exercise on femoral vein hemodynamics and lower limb fatigue in healthy adults[J]. Chin J Mod Nurs, 2023, 29(4):488-492.
[11]	中华护理学会. 成人住院患者静脉血栓栓塞症的预防护理[S/OL]. (2023-01-31)[2024-09-16]. http://hltb.kxj.org.cn/index/tuanti/standard.html?team_standard_id=33.
	China Nurse Association. Preventive care of venous throm-boembolism for adult inpatients[S/OL]. (2023-01-31)[2024-09-16]. http://hltb.kxj.org.cn/index/tuanti/standard.html?team_standard_id=33.
[12]	Lenze EJ, Munin MC, Quear T, et al. The Pittsburgh Rehabilitation Participation Scale:reliability and validity of a clinician-rated measure of participation in acute rehabilitation[J]. Arch Phys Med Rehabil, 2004, 85(3):380-384.
[13]	侯永辉, 刘瑛, 魏国荣, 等. 匹兹堡康复参与量表的预测效度和信度研究[J]. 中国康复医学杂志, 2014, 29(2):150-152.
	Hou YH, Liu Y, Wei GR, et al. Predictive validity and reliability of Pittsburgh Rehabilitation Participation Scale[J]. Chin J Rehabil Med, 2014, 29(2):150-152.
[14]	Borg GA. Psychophysical bases of perceived exertion[J]. Med Sci Sports Exerc, 1982, 14(5):377-381.
[15]	Tabben M, Tourny C, Haddad M, et al. Validity and reliability of the session-RPE method for quantifying training load in karate athletes[J]. J Sports Med Phys Fitness, 2015, 45(5S):370.
[16]	Resnick B, Jenkins LS. Testing the reliability and validity of the Self-efficacy for Exercise Scale[J]. Nurs Res, 2000, 49(3):154-159. DOI PMID
[17]	Lee LL, Perng SJ, Ho CC, et al. A preliminary reliability and validity study of the Chinese version of the Self-efficacy for Exercise Scale for older adults[J]. Int J Nurs Stud, 2009, 46(2):230-238.
[18]	Chen X, Wang YF, Jia RF, et al. Intermittent pneumatic com-pression(IPC) combined with an electric stimulator in the prevention of venous thromboembolism in stroke patients[J]. Am J Transl Res, 2021, 13(9):10837-10842.
[19]	陆秋芳, 应燕萍, 覃艳勤, 等. 急性期脑卒中患者下肢深静脉血栓风险预测模型的构建及应用[J]. 中华护理杂志, 2022, 57(16):1948-1955.
	Lu QF, Ying YP, Qin YQ, et al. Establishment of a nomogram model for predicting the risk of deep vein thrombosis in patients with acute stroke[J]. Chin J Nurs, 2022, 57(16):1948-1955.
[20]	唐文娟, 石贞仙, 张彩云, 等. 脑卒中患者发生深静脉血栓危险因素的Meta分析[J]. 中华护理杂志, 2019, 54(7):989-994. DOI
	Tang WJ, Shi ZX, Zhang CY, et al. Risk factors of deep venous thrombosis in stroke patients:a Meta-analysis[J]. Chin J Nurs, 2019, 54(7):989-994.
[21]	陈立君, 张阳, 靳宝莲, 等. 间歇性气压联合踝泵运动对老年急性缺血性脑卒中患者住院期间下肢深静脉血栓的预防价值[J]. 血管与腔内血管外科杂志, 2024, 10(3):287-291.
	Chen LJ, Zhang Y, Jin BL, et al. Preventive value of intermittent barometric pressure combined with ankle pump exercise for lower extremity deep vein thrombosis in elderly patients with acute ischemic stroke during hospitalization[J]. J Vasc Endovasc Surg, 2024, 10(3):287-291.
[22]	O’Connor DJ, Scher LA, Gargiulo NJ, et al. Incidence and cha-racteristics of venous thromboembolic disease during pregnancy and the postnatal period:a contemporary series[J]. Ann Vasc Surg, 2011, 25(1):9-14.
[23]	Figueiredo P, Rouard A, Vilas-Boas JP, et al. Upper-and lower-limb muscular fatigue during the 200-m front crawl[J]. Appl Physiol Nutr Metab, 2013, 38(7):716-724. DOI PMID
[24]	张远星, 陈璐, 季翠玲, 等. 中青年出血性脑卒中患者功能锻炼依从性的影响因素及路径分析[J]. 护理学报, 2022, 29(20):6-10.
	Zhang YX, Chen L, Ji CL, et al. Influencing factors and pathway analysis of functional exercise adherence in young and middle-aged patients with hemorrhagic stroke[J]. J Nurs(China), 2022, 29(20):6-10.