握力大小对留置PICC肿瘤患者腋静脉血流动力学的影响
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摘要
目的探讨肿瘤患者置入PICC导管后握力大小对上肢静脉血流动力学的影响,为握球锻炼提供科学依据。方法采用前瞻性临床观察的研究方法,选取北京市某三级甲等医院2018年7-8月收治的40例置入PICC导管的肿瘤患者,采用自身前后对照的方法使用握力器进行握力,并在超声监测下观察不同握力大小对静脉血管直径、血流速度和血管压力的影响。结果患者在静息状态下静脉血流的血管直径为(4.18±0.83)mm,血流峰速度为(12.39±3.17)cm/s,静脉对血管壁的压力为(0.06±0.03)mmHg,不同握力大小下血管直径比较差异无统计学意义(P>0.05)、血流峰速度和血管压力比较有统计学意义(P<0.05),所有不同握力大小下的静脉血流动力学变化均有统计学意义,其中使用80%最大握力、90%最大握力、100%最大握力握力后静脉血流峰速度和静脉血管压力与静息状态下比较差异有统计学意义(P<0.05)。结论握力可有效增加静脉血流速度,加大静脉对血管壁的压力,未引起患者不适,可用于指导临床上置入PICC导管的肿瘤患者进行功能锻炼。80%最大握力～100%最大握力范围内的握力为患者功能锻炼时最适宜的握力大小,可用于临床推广使用。
Objective To discuss the influence of grip strength on hemodynamics of upper limb veins after the implantation of PICC in patients with tumors and to provide scientific basis for the exercise of holding the ball. Methods We conducted prospective clinical observation and 40 patients with PICC catheter implanted in a tertiary grade A hospital in Beijing from July to August 2018 were selected. Patients performed with gripper to measure grip strength by self contrast method, and the effects of grip force on venous vessel diameter, blood flow velocity and blood pressure were observed by ultrasound. Results In rest state, the vessel diameter of venous blood flow was(4.18±0.83) mm; the peak velocity was(12.39±3.17) cm/s and the pressure of vein to vessel wall was(0.06±0.03)mmHg. There was no significant difference in vessel diameter with different grip strength(P>0.05) but there was in peak velocity and pressure of blood flow(P<0.05). The changes of venous hemodynamics with different grip strength were statistically significant. The peak velocity and pressure of venous blood flow after using 80% maximum grip strength(MGS), 90% MGS and 100% MGS were significantly different from those in rest state(P <0.05). Conclusion Gripping force can effectively increase venous blood flow velocity and venous pressure on the vascular wall, but it does not cause discomfort to patients. It can be used to guide clinical patients with PICC for functional exercise. The pressure of 80% MGS-100% MGS is the most suitable grip strength, which can be promoted in clinical practice.
Objective To discuss the influence of grip strength on hemodynamics of upper limb veins after the implantation of PICC in patients with tumors and to provide scientific basis for the exercise of holding the ball. Methods We conducted prospective clinical observation and 40 patients with PICC catheter implanted in a tertiary grade A hospital in Beijing from July to August 2018 were selected. Patients performed with gripper to measure grip strength by self contrast method, and the effects of grip force on venous vessel diameter, blood flow velocity and blood pressure were observed by ultrasound. Results In rest state, the vessel diameter of venous blood flow was(4.18±0.83) mm; the peak velocity was(12.39±3.17) cm/s and the pressure of vein to vessel wall was(0.06±0.03)mmHg. There was no significant difference in vessel diameter with different grip strength(P>0.05) but there was in peak velocity and pressure of blood flow(P<0.05). The changes of venous hemodynamics with different grip strength were statistically significant. The peak velocity and pressure of venous blood flow after using 80% maximum grip strength(MGS), 90% MGS and 100% MGS were significantly different from those in rest state(P <0.05). Conclusion Gripping force can effectively increase venous blood flow velocity and venous pressure on the vascular wall, but it does not cause discomfort to patients. It can be used to guide clinical patients with PICC for functional exercise. The pressure of 80% MGS-100% MGS is the most suitable grip strength, which can be promoted in clinical practice.
引文
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[7]伦雪萍,陈慕瑶,周海燕,等.上肢运动操在预防PICC置管患者并发静脉血栓中的应用[J].临床医药文献电子杂志,2014,1(6):966.DOI:10.16281/j.cnki.jocml.2014.06.049.
[8]曹轶,马俊,金燕萍.湿热敷联合使用握力器降低经外周静脉穿刺中心静脉置管致机械性静脉炎的发生[J].解放军护理杂志,2015,32(11):55-57.DOI:10.3969/j.issn.1008-9993.2015.11.017.
[9]王敏.主动握拳活动对预防PICC相关上肢静脉血栓形成的效果[J].护理实践与研究,2016,13(22):141-142.DOI:10.3969/j.issn.1672-9676.2016.22.058.
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[11]Helen C R,Hayley J D,Helen J M,et al.A review of the Measurement of Grip Strength in Clinical and Epidemiological Studies:towards a Standardised Approach[J].Age and Ageing,2011,40(4):423-429.DOI:org/10.1093/ageing/afr051.
[12]Cooper R,Kuh D,Cooper C,et al.Objective Measures of Physical Capability and Subsequent Health:A Systematic Review[J].Age Ageing,2011,40(1):14-23.DOI:10.1093/ageing/afq117.
[13]Hebert L E,Scherr P A,McCann J J,et al.Change in Direct Measures of Physical Performance among Persons with Alzheimer’s Disease[J].Aging Ment Health,2008,12(6):729-734.DOI:10.1080/13607860802154390.
[14]Cawthon P M,Fullman R L,Marshall L,et al.Physical Performance and Risk of Hip Fractures in Older Men[J].JBone Miner Res,2008,23(7):1037-1044.DOI:10.1359/jbmr.080227.
[15]Sirola J,Rikkonen T,Tuppurainen M,et al.Grip Strength may Facilitate Fracture Prediction in Perimenopausal Women with Normal BMD:A 15-year Population-based Study[J].Calcif Tissue Int,2008,83(2):93-100.DOI:10.1007/s00223-008-9155-0.
[16]Cooper R,Kuh D,Hardy R.Objectively Measured Physical Capability Levels and Mortality:Systematic Review and Metaanalysis[J].BMJ,2010,341:c4467.DOI:10.1136/bmj.c4467.
[17]Sasaki H,Kasagi F,Yamada M,et al.Grip Strength Predicts Cause-specific Mortality in Middle-aged and Elderly Persons[J].Am J Med,2007,120(4):337-342.DOI:10.1016/j.amjmed.2006.04.018.
[18]Liu K,Zhou Y,Xie W,et al.Handgrip Exercise Reduces Peripherally-inserted Central Catheter-related Venous Thrombosis in Patients with Solid Cancers:A Randomized Controlled Trial[J].Int J Nurs Stud,2018,86:99-106.DOI:org/10.1016/j.ijnurstu.2018.06.004.
[19]Nifong T P,McDevitt T J.The Effect of Catheter to Vein ratio on Blood Flow Rates in a Simulated Model of Peripherally Inserted Central Venous Catheters[J].Chest,2011,140(1):48-53.DOI:10.1378/chest.10-2637.
[2]Chopra V,Anand S,Krein S L,et al.Bloodstream Infection Venous Thrombosis,and Peripherally Inserted Central Catheters:Reappraising the Evidence[J].Am J Med,2012,125(8)733-741.DOI:10.1016/j.amjmed.2012.04.010.
[3]张建薇,傅荣.握拳运动在预防老年PICC置管患者上肢深静脉血栓中的应用效果[J].中华现代护理杂志,2018,24(4):440-442.DOI:10.3760/cma.j.issn.1674-2907.2018.04.016.
[4]惠慧,马燕兰,郭艳艳,等.不同握球运动还是对PICC置管患者静脉血流及相关性血栓的影响[J].中华现代护理杂志,2018,24(12):1391-1398.DOI:10.3760/cma.j.issn.1674-2907.2018.12.008.
[5]周晔.不同频次的握拳运动对PICC相关性血栓的影响[D].南京:南京医科大学,2015.
[6]江小好,卓雅淑,蒋静婷.海绵球锻炼预防PICC致机械性静脉炎的临床效果[J].实用医学杂志,2015,31(5):844-846.DOI:10.3969/j.issn.1006-5725.2015.05.051.
[7]伦雪萍,陈慕瑶,周海燕,等.上肢运动操在预防PICC置管患者并发静脉血栓中的应用[J].临床医药文献电子杂志,2014,1(6):966.DOI:10.16281/j.cnki.jocml.2014.06.049.
[8]曹轶,马俊,金燕萍.湿热敷联合使用握力器降低经外周静脉穿刺中心静脉置管致机械性静脉炎的发生[J].解放军护理杂志,2015,32(11):55-57.DOI:10.3969/j.issn.1008-9993.2015.11.017.
[9]王敏.主动握拳活动对预防PICC相关上肢静脉血栓形成的效果[J].护理实践与研究,2016,13(22):141-142.DOI:10.3969/j.issn.1672-9676.2016.22.058.
[10]Fess E,Moran C.Clinical Assessment Recommendations[M].Philadelphia:American Society of Hand Therapists Monograph,1981.
[11]Helen C R,Hayley J D,Helen J M,et al.A review of the Measurement of Grip Strength in Clinical and Epidemiological Studies:towards a Standardised Approach[J].Age and Ageing,2011,40(4):423-429.DOI:org/10.1093/ageing/afr051.
[12]Cooper R,Kuh D,Cooper C,et al.Objective Measures of Physical Capability and Subsequent Health:A Systematic Review[J].Age Ageing,2011,40(1):14-23.DOI:10.1093/ageing/afq117.
[13]Hebert L E,Scherr P A,McCann J J,et al.Change in Direct Measures of Physical Performance among Persons with Alzheimer’s Disease[J].Aging Ment Health,2008,12(6):729-734.DOI:10.1080/13607860802154390.
[14]Cawthon P M,Fullman R L,Marshall L,et al.Physical Performance and Risk of Hip Fractures in Older Men[J].JBone Miner Res,2008,23(7):1037-1044.DOI:10.1359/jbmr.080227.
[15]Sirola J,Rikkonen T,Tuppurainen M,et al.Grip Strength may Facilitate Fracture Prediction in Perimenopausal Women with Normal BMD:A 15-year Population-based Study[J].Calcif Tissue Int,2008,83(2):93-100.DOI:10.1007/s00223-008-9155-0.
[16]Cooper R,Kuh D,Hardy R.Objectively Measured Physical Capability Levels and Mortality:Systematic Review and Metaanalysis[J].BMJ,2010,341:c4467.DOI:10.1136/bmj.c4467.
[17]Sasaki H,Kasagi F,Yamada M,et al.Grip Strength Predicts Cause-specific Mortality in Middle-aged and Elderly Persons[J].Am J Med,2007,120(4):337-342.DOI:10.1016/j.amjmed.2006.04.018.
[18]Liu K,Zhou Y,Xie W,et al.Handgrip Exercise Reduces Peripherally-inserted Central Catheter-related Venous Thrombosis in Patients with Solid Cancers:A Randomized Controlled Trial[J].Int J Nurs Stud,2018,86:99-106.DOI:org/10.1016/j.ijnurstu.2018.06.004.
[19]Nifong T P,McDevitt T J.The Effect of Catheter to Vein ratio on Blood Flow Rates in a Simulated Model of Peripherally Inserted Central Venous Catheters[J].Chest,2011,140(1):48-53.DOI:10.1378/chest.10-2637.