Effect of early ambulation on postoperative recovery in liver transplant patients admitted to ICU

doi:10.3877/cma.j.issn.1674-6880.2026.02.006

Abstract

Abstract:

Objective

To investigate the effect of early ambulation on postoperative rehabilitation in ICU patients undergoing liver transplantation.

Methods

Based on the intervention timing under the early progressive activity regimen, liver transplant patients between December 2022 and June 2024 were divided into an observation group and a control group, with 28 patients in each group. The observation group initiated a progressive activity regimen on the first post-transplantation day, while the control group began the same regimen on the seventh postoperative day. The clinical indicators (endotracheal tube retention time, gastric tube retention time, liver transplant ICU hospitalization time, and total hospitalization duration), recovery indicators [Rivermead mobility index (RMT) and manual muscle test (MMT)], and liver and kidney function indicators [alanine aminotransferase (ALT), aspartate aminotransferase (AST), total bilirubin, urea, and creatinine] on the day before the operation (T0) and on the 2nd, 4th, 6th, 8th, 10th, 12th, and 14th days after the operation (T1 to T7) were compared between the two groups.

Results

The endotracheal tube retention time (Z = 3.543, P < 0.001), gastric tube retention time (Z = 3.260, P = 0.001), liver transplant ICU hospitalization time (Z = 3.271, P = 0.001), and total hospitalization time (Z = 2.943, P = 0.003) of the observation group were all significantly shorter than those of the control group. Two weeks after the operation, the MMT (Z = 3.533, P < 0.001) and RMI (Z = 3.159, P = 0.002) of patients in the observation group were significantly higher than those in the control group. There were significant differences in the levels of ALT (χ² = 295.510, P < 0.001), AST (χ² = 311.721, P < 0.001), and total bilirubin (χ² = 145.279, P < 0.001) between the two groups at all time points before and after the operation. Moreover, the levels of ALT and AST in the observation group were much lower than those in the control group at the T2 time point (both P < 0.05), and the total bilirubin level in the observation group was much lower than that in the control group during the T5 to T7 period (all P < 0.05). There were no statistically significant differences in the levels of urea (F = 3.433, P = 0.069) and creatinine (F = 0.063, P = 0.803) at all time points before and after the operation between the two groups.

Conclusion

Early ambulation after liver transplantation is beneficial for postoperative recovery.

Key words: Liver transplantation, Early ambulation, Intensive care unit, Postoperative rehabilitation

Rouna Wu, Juehan Wang, Denghuang Fan, Wangxiao Bao, Lin Mao, Daming Wang. Effect of early ambulation on postoperative recovery in liver transplant patients admitted to ICU[J]. Chinese Journal of Critical Care Medicine(Electronic Edition), 2026, 19(02): 131-138.

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Figures/Tables 5

References 33

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时间阶段	对照组	观察组
术后1 ~ 6 d	常规康复方案： 1.每日床头抬高≤ 45°半卧位 2.床上肢体训练：上肢活动训练（15 ~ 20个/动作，1 ~ 2次/d）；下肢活动训练（15 ~ 20个/动作，1 ~ 2次/d） 3.心肺功能训练：腹式呼吸训练（5 ~ 10 min/次，3 ~ 4次/d）；有效咳嗽训练（3 ~ 4次/d）	在每日进行常规康复方案的基础上增加早期渐进式活动： 1.术后第1天：每日床头抬高+床上肢体训练+心肺训练（实施常规康复方案） 2.术后第2天：床边坐起（10 ~ 15 min/次，1 ~ 2次/d） 3.术后第3天：床边站立（5 ~ 10 min/次，1 ~ 2次/d） 4.术后第4天：床边行走（5 ~ 10 min/次，1 ~ 2次/d） 5.术后5 ~ 6 d：重复第4天方案
术后7 ~ 14 d	按照常规康复方案+早期渐进式活动方案进行活动管理： 1.术后第7天：每日床头抬高+床上肢体训练+心肺训练（实施常规康复方案） 2.术后第8天：床边坐起（10 ~ 15 min/次，1 ~ 2次/d） 3.术后第9天：床边站立（5 ~ 10 min/次，1 ~ 2次/d） 4.术后第10天：床边踏步（5 ~ 10 min/次，1 ~ 2次/d） 5.术后11 ~ 14 d：重复第10天方案	延续术后第4天方案：常规康复方案+床边行走训练（5 ~ 10 min/次，1 ~ 2次/d）

时间阶段	对照组	观察组
术后1 ~ 6 d	常规康复方案： 1.每日床头抬高≤ 45°半卧位 2.床上肢体训练：上肢活动训练（15 ~ 20个/动作，1 ~ 2次/d）；下肢活动训练（15 ~ 20个/动作，1 ~ 2次/d） 3.心肺功能训练：腹式呼吸训练（5 ~ 10 min/次，3 ~ 4次/d）；有效咳嗽训练（3 ~ 4次/d）	在每日进行常规康复方案的基础上增加早期渐进式活动： 1.术后第1天：每日床头抬高+床上肢体训练+心肺训练（实施常规康复方案） 2.术后第2天：床边坐起（10 ~ 15 min/次，1 ~ 2次/d） 3.术后第3天：床边站立（5 ~ 10 min/次，1 ~ 2次/d） 4.术后第4天：床边行走（5 ~ 10 min/次，1 ~ 2次/d） 5.术后5 ~ 6 d：重复第4天方案
术后7 ~ 14 d	按照常规康复方案+早期渐进式活动方案进行活动管理： 1.术后第7天：每日床头抬高+床上肢体训练+心肺训练（实施常规康复方案） 2.术后第8天：床边坐起（10 ~ 15 min/次，1 ~ 2次/d） 3.术后第9天：床边站立（5 ~ 10 min/次，1 ~ 2次/d） 4.术后第10天：床边踏步（5 ~ 10 min/次，1 ~ 2次/d） 5.术后11 ~ 14 d：重复第10天方案	延续术后第4天方案：常规康复方案+床边行走训练（5 ~ 10 min/次，1 ~ 2次/d）

组别	例数	男/女（例）	年龄（岁， ± s）	BMI（kg/m²， ± s）	手术时间[h，M（P₂₅，P₇₅）]	术中出血量[mL，M（P₂₅，P₇₅）]	升压药（例，有/无）
观察组	28	20/8	50 ± 9	23 ± 4	6.0（5.5，6.9）	2 000（1 125，2 500）	9/19
对照组	28	19/9	52 ± 10	23 ± 4	6.0（5.5，7.5）	1 800（1 150，3 000）	15/13
t/χ²/Z值		0.084	0.482	0.218	0.349	0.191	2.625
P值		0.771	0.632	0.828	0.727	0.848	0.105

组别	例数	男/女（例）	年龄（岁， ± s）	BMI（kg/m²， ± s）	手术时间[h，M（P₂₅，P₇₅）]	术中出血量[mL，M（P₂₅，P₇₅）]	升压药（例，有/无）
观察组	28	20/8	50 ± 9	23 ± 4	6.0（5.5，6.9）	2 000（1 125，2 500）	9/19
对照组	28	19/9	52 ± 10	23 ± 4	6.0（5.5，7.5）	1 800（1 150，3 000）	15/13
t/χ²/Z值		0.084	0.482	0.218	0.349	0.191	2.625
P值		0.771	0.632	0.828	0.727	0.848	0.105

组别	时间	例数	ALT[U/L，M（P₂₅，P₇₅）]	AST[U/L，M（P₂₅，P₇₅）]	总胆红素[μmol/L，M（P₂₅，P₇₅）]	尿素（mmol/L， ± s）	肌酐（μmol/L， ± s）
观察组
	T0	28	37.00（21.50，70.50）	51.00（38.50，88.00）	194.50（54.10，464.10）	4.9 ± 2.8	66 ± 38
	T1	28	503.50（261.25，628.75）^a	1 172.50（665.50，2 114.25）^a	102.40（72.50，202.60）	8.5 ± 2.8	81 ± 31
	T2	28	367.50（214.50，668.00）^ab	460.50（342.50，742.00）^ab	106.40（59.90，186.80）	10.2 ± 3.4	79 ± 37
	T3	28	294.50（184.00，611.00）^a	254.00（141.25，362.25）^a	89.10（59.70，194.80）	9.9 ± 3.3	75 ± 39
	T4	28	183.50（122.00，425.25）^ac	93.00（74.50，149.75）^cd	90.30（38.20，143.40）	8.4 ± 3.1	67 ± 39
	T5	28	150.00（84.75，302.25）^cde	57.00（40.00，89.25）^cde	59.60（25.80，116.50）^abcd	8.6 ± 3.5	67 ± 39
	T6	28	121.50（61.50，226.00）^cdef	38.50（30.25，54.25）^cdef	43.50（20.70，98.60）^abcde	9.0 ± 3.8	72 ± 56
	T7	28	90.00（50.75，189.75）^cdef	33.50（28.25，51.25）^cdef	26.80（13.40，46.40）^abcdef	8.2 ± 3.0	68 ± 39
对照组
	T0	28	55.50（31.25，100.50）	73.00（45.25，91.25）	362.85（255.48，494.00）	6.2 ± 5.0	69 ± 48
	T1	28	672.50（303.00，1 581.75）^a	1 231.00（838.75，3 422.00）^a	154.45（81.55，253.23）^a	10.5 ± 5.3	84 ± 41
	T2	28	817.50（254.25，1 518.75）^a	936.00（332.50，2 242.00）^a	161.60（84.10，230.38）^a	12.0 ± 6.2	82 ± 47
	T3	28	636.00（209.75，1 057.00）^a	329.50（130.00，809.75）^a	130.80（95.20，221.80）^a	11.8 ± 6.5	76 ± 41
	T4	28	405.00（135.50，714.50）^acd	145.50（61.25，273.75）^cd	119.85（68.18，204.08）^a	10.2 ± 5.5	69 ± 34
	T5	28	270.50（80.50，428.00）^cde	70.00（34.25，149.25）^cde	125.20（63.03，185.48）^a	9.5 ± 5.8	67 ± 33
	T6	28	175.50（71.50，224.75）^cdef	51.00（32.50，88.75）^cdef	82.75（31.43，191.75）^a	10.9 ± 6.3	72 ± 37
	T7	28	113.50（61.25，186.75）^cdef	37.50（27.00，65.00）^cdef	77.75（41.63，146.50）^ae	11.4 ± 7.1	76 ± 36
χ²/F值			295.510	311.721	145.279	3.433	0.063
P值			< 0.001	< 0.001	< 0.001	0.069	0.803

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