大部分关于危重症患者的康复介入指标侧重于呼吸频率、氧合指数等呼吸系统指征以及血流动力学、血管活性药物使用等心血管指征。
对发热患者介入标准未有明确的建议，但后台收到很多老师关于这个问题的私信，对于这类患者，能否早期活动呢？如果可以，体温的临界值是什么？
带着疑问，查询了些资料，供同样有疑问的同行参考！
· 一、发热的定义与激活途径 ·
发热（fever）是指机体在致热源或者各种原因引起的体温调节中枢功能障碍时，体温超出正常范围。其发热机制包括外源性致热源与内源性致热源。
· 二、早期活动体温临界值 ·
Body temperature < 38℃
图片来源：Stiller K. Safety issues that should be considered when mobilizing critically ill patients. Crit Care Clin. 2007.
经处理后，体温仍超出可接受值
图片来源;Hodgson
CL, Stiller K, Needham DM, et al. Expert consensus and recommendations
on safety criteria for active mobilization of mechanically ventilated
critically ill adults. Crit Care. 2014.
No body temperature ≥38.5℃
No body temperature ≤36℃
图片来源：Sommers
J, Engelbert RH, Dettling-Ihnenfeldt D, et al. Physiotherapy in the
intensive care unit: an evidence-based, expert driven, practical
statement and rehabilitation recommendations.2015.
No body temperature ≥ 38℃
图片来源：Yang
R, Zheng Q, Zuo D, Zhang C, Gan X. Safety Assessment Criteria for Early
Active Mobilization in Mechanically Ventilated ICU Subjects. Respir
Care. 2021.
Body temperature < 38.5°
图片来源：Alaparthi
GK, Gatty A, Samuel SR, Amaravadi SK. Effectiveness, Safety, and
Barriers to Early Mobilization in the Intensive Care Unit. Crit Care Res
Pract. 2020;
· 总结 ·
目前关于发热患者早期介入的体温临界值尚未明确，相当部分研究中将体温标准临界值定为38℃，也有部分将排除标准定为38.5℃。
但在临床实际操作过程中，我们需要明白发热是人体对致病因子的一种病理生理反应，并不是独立的疾病，在疾病发展过程中体温的升高往往同时伴有内分泌、免疫和诸多生理功能的广泛激活，造成呼吸系统、心血管系统的改变。因此在早期康复介入过程中需时刻警惕患者心肺氧供系统指标的波动！
· 参考文献 ·
[1]张文宏,李太生.发热待查诊治专家共识[J].上海医学,2018,41(07):385-400.
[2]StillerK. Safety issues that should be considered when mobilizing critically
ill patients. Crit Care Clin. 2007;23(1):35-53.
doi:10.1016/j.ccc.2006.11.005
[3]HodgsonCL, Stiller K, Needham DM, et al. Expert consensus and recommendations
on safety criteria for active mobilization of mechanically ventilated
critically ill adults. Crit Care. 2014;18(6):658. Published 2014 Dec 4.
doi:10.1186/s13054-014-0658-y
[4]SommersJ, Engelbert RH, Dettling-Ihnenfeldt D, et al. Physiotherapy in the
intensive care unit: an evidence-based, expert driven, practical
statement and rehabilitation recommendations. Clin Rehabil.
2015;29(11):1051-1063. doi:10.1177/0269215514567156
[5]YangR, Zheng Q, Zuo D, Zhang C, Gan X. Safety Assessment Criteria for Early
Active Mobilization in Mechanically Ventilated ICU Subjects. Respir
Care. 2021;66(2):307-315. doi:10.4187/respcare.07888
[6]AlaparthiGK, Gatty A, Samuel SR, Amaravadi SK. Effectiveness, Safety, and
Barriers to Early Mobilization in the Intensive Care Unit. Crit Care Res
Pract. 2020;2020:7840743. Published 2020 Nov 26.
doi:10.1155/2020/7840743.
