早期康复锻炼对心脏外科术后患者预后的影响
|
摘要
目的:探讨早期康复锻炼对心脏外科术后患者预后的影响。方法:选取2016年1月至2018年1月期间在我院成人心脏外科术后重症监护室(ICU)停留大于48 h患者893例,根据是否开展早期康复锻炼分为早期康复组239例和传统治疗组654例,经过倾向性评分进行1:1匹配每组192例,分析两组患者预后指标差异。结果:早期康复组与传统治疗组比较,机械通气时间缩短[(36.0±14.9)hvs (43.0±12.5)h,P=0.016],镇静药物使用减少[(39.0±16.8)h vs (47.0±21.3)h,P=0.001],谵妄发生率降低(7.81%vs 17.19%,P=0.006),肠道功能紊乱发生率降低(26.56%vs 42.71%,P=0.001),营养不良风险降低[肱三头肌皮褶厚度(12.0±3.3) mm vs(15.0±2.8) mm,P=0.021],但两组患者ICU停留时间、院内感染发生率、器械辅助使用率、气管切开、非计划拔管、空肠营养管置管及运动耐量随访等指标差异均无统计学意义(P均>0.05)。结论:心脏外科术后早期康复锻炼对患者预后指标有一定改善。
Objectives: To investigate the effect of early rehabilitation exercise on prognosis of patients after cardiac surgery.Methods: Present retrospective analysis included 893 patients hospitalized for more than 48 hours after cardiac surgery in ICU from January 2016 to January 2018. Among them, 239 cases were grouped in early rehabilitation group and 654 cases were grouped in traditional treatment group. 192 cases from each group were matched by 1:1 propensity score. The difference of prognostic indicators between the two groups was analyzed.Results: The mechanical ventilation time was significantly short([36.0±14.9] h vs [43.0±12.5] h, P=0.016), the sedative drug use was reduced([39.0±16.8] h vs [47.0±21.3] h, P=0.001), the incidence of delirium was decreased(7.81% vs 17.19%,P=0.006), the incidence of intestinal dysfunction was decreased(26.56% vs 42.71%, P=0.001), and the risk of malnutrition was reduced(Triceps skinfold [15.0±2.8] mm vs [12.0±3.3] mm, P=0.021) in the early rehabilitation group as compared to the traditional treatment group, but there were no significant differences in ICU length of stay, nosocomial infection rate,mechanical support rate, tracheotomy, unplanned extubation, jejunal nutrition tube placement, and exercise tolerance during follow-up between the two groups.Conclusions: Early rehabilitation exercise after cardiac surgery is safe and feasible, and some prognosis indicators could be improved by early rehabilitation exercise after cardiac surgery.
Objectives: To investigate the effect of early rehabilitation exercise on prognosis of patients after cardiac surgery.Methods: Present retrospective analysis included 893 patients hospitalized for more than 48 hours after cardiac surgery in ICU from January 2016 to January 2018. Among them, 239 cases were grouped in early rehabilitation group and 654 cases were grouped in traditional treatment group. 192 cases from each group were matched by 1:1 propensity score. The difference of prognostic indicators between the two groups was analyzed.Results: The mechanical ventilation time was significantly short([36.0±14.9] h vs [43.0±12.5] h, P=0.016), the sedative drug use was reduced([39.0±16.8] h vs [47.0±21.3] h, P=0.001), the incidence of delirium was decreased(7.81% vs 17.19%,P=0.006), the incidence of intestinal dysfunction was decreased(26.56% vs 42.71%, P=0.001), and the risk of malnutrition was reduced(Triceps skinfold [15.0±2.8] mm vs [12.0±3.3] mm, P=0.021) in the early rehabilitation group as compared to the traditional treatment group, but there were no significant differences in ICU length of stay, nosocomial infection rate,mechanical support rate, tracheotomy, unplanned extubation, jejunal nutrition tube placement, and exercise tolerance during follow-up between the two groups.Conclusions: Early rehabilitation exercise after cardiac surgery is safe and feasible, and some prognosis indicators could be improved by early rehabilitation exercise after cardiac surgery.
引文
[1]Eichler S,Salzwedel A,Reibis R,et al.Multicomponent cardiac rehabilitation in patients after transcatheter aortic valve implantation:Predictors of functional and psychocognitive recovery[J].Eur J Prev Cardiol,2017,24(3):257-264.DOI:10.1177/2047487316679527.
[2]中国加速康复外科专家组.中国加速康复外科围手术期管理专家共识(2016)[J].中华外科杂志,2016,54(6):413-418.DOI:10.3760/cma.j.issn.0529-5815.2016.06.004.
[3]Herdy AH,Marcchi PL,Vila A,et al.Pre-and postoperative cardiopulmonary rehabilitation in hospitalized patients undergoing coronary artery bypass surgery:a randomized controlled trial[J].Am J Phys Med Rehabil,2008,87(9):714-719.DOI:10.1097/PHM.0b013e3181839152.
[4]Che L,Gong Z,Jiang JF,et al.Effects of exercise therapy at the intensity of anaerobic threshold for exercise tolerance in patients with chronic stable coronary artery disease[J].Zhonghua Yi Xue Za Zhi,2011,91(24):1659-1662.DOI:10.3760/cma.j.issn.0376-2491.2011.24.002.
[5]Reintam BA,Malbrain ML,Starkopf J,et al.Gastrointestinal function in intensive care patients:terminology,definitions and management.Recommendations of the ESICM working group on abdominal problems[J].Intensive Care Med,2012,38(3):384-394.DOI:10.1007/s00134-011-2459-y.
[6]Barr J,Fraser GL,Puntillo K,et al.Clinical practice guidelines for the management of pain,agitation,and delirium in adult patients in the intensive care unit[J].Crit Care Med,2013,41(1):263-306.DOI:10.1097/CCM.0b013e3182783b72.
[7]Levett DZ,Grocott MP.Cardiopulmonary exercise testing,prehabilitation,and enhanced recovery after surgery(ERAS)[J].Can J Anaesth,2015,62(2):131-142.DOI:10.1007/s12630-014-0307-6.
[8]冯雪,李四维,吴岳,等.Ⅰ期心脏康复对冠状动脉旁路移植术后患者的短期疗效观察[J].中国循环杂志,2017,32(4):318-321.DOI:10.3969/j.issn.1000-3614.2017.04.003.
[9]Russo N,Compostella L,Tarantini G,et al.Cardiac rehabilitation after transcatheter versus surgical prosthetic valve implantation for aortic stenosis in the elderly[J].Eur J Prev Cardiol,2014,21(11):1341-1348.DOI:10.1177/2047487313494029.
[10]Mazzuco A,Medeiros WM,Souza AS,et al.Are heart rate dynamics in the transition from rest to submaximal exercise related to maximal cardiorespiratory responses in COPD?[J].Braz J Phys Ther,2017,21(4):251-258.DOI:10.1016/j.bjpt.2017.05.002.
[11]邵迴龙,梁家立,钟萍,等.运动锻炼对冠状动脉旁路移植术患者心率变异性的影响[J].心血管康复医学杂志,2013,22(1):10-14.DOI:10.3969/j.issn.1008-0074.2013.01.03.
[12]渠林楠,崔玉芳,虞彬.早期康复对经桡动脉行急诊PCI的急性心梗患者左室射血分数及运动耐量的影响[J].实用临床医药杂志,2017,21(8):5-7.DOI:10.7619/jcmp.201708002.
[13]Spiroski D,Andjic M,Stojanovic OI,et al.Very short/short-term benefit of inpatient/outpatient cardiac rehabilitation programs after coronary artery bypass grafting surgery[J].Clin Cardiol,2017,40(5):281-286.DOI:10.1002/clc.22656.
[14]Bisca GW,Camillo CA,Cavalheri V,et al.Peripheral muscle training in patients with chronic obstructive pulmonary disease:novel approaches and recent advances[J].Expert Rev Respir Med,2017,11(5):413-423.DOI:10.1080/17476348.2017.1317598.
[15]许晶晶.心血管疾病的心脏康复[J].中国循环杂志,2013,28(8):635-637.DOI:10.3969/j.issn.1000-3614.2013.08.021.
[2]中国加速康复外科专家组.中国加速康复外科围手术期管理专家共识(2016)[J].中华外科杂志,2016,54(6):413-418.DOI:10.3760/cma.j.issn.0529-5815.2016.06.004.
[3]Herdy AH,Marcchi PL,Vila A,et al.Pre-and postoperative cardiopulmonary rehabilitation in hospitalized patients undergoing coronary artery bypass surgery:a randomized controlled trial[J].Am J Phys Med Rehabil,2008,87(9):714-719.DOI:10.1097/PHM.0b013e3181839152.
[4]Che L,Gong Z,Jiang JF,et al.Effects of exercise therapy at the intensity of anaerobic threshold for exercise tolerance in patients with chronic stable coronary artery disease[J].Zhonghua Yi Xue Za Zhi,2011,91(24):1659-1662.DOI:10.3760/cma.j.issn.0376-2491.2011.24.002.
[5]Reintam BA,Malbrain ML,Starkopf J,et al.Gastrointestinal function in intensive care patients:terminology,definitions and management.Recommendations of the ESICM working group on abdominal problems[J].Intensive Care Med,2012,38(3):384-394.DOI:10.1007/s00134-011-2459-y.
[6]Barr J,Fraser GL,Puntillo K,et al.Clinical practice guidelines for the management of pain,agitation,and delirium in adult patients in the intensive care unit[J].Crit Care Med,2013,41(1):263-306.DOI:10.1097/CCM.0b013e3182783b72.
[7]Levett DZ,Grocott MP.Cardiopulmonary exercise testing,prehabilitation,and enhanced recovery after surgery(ERAS)[J].Can J Anaesth,2015,62(2):131-142.DOI:10.1007/s12630-014-0307-6.
[8]冯雪,李四维,吴岳,等.Ⅰ期心脏康复对冠状动脉旁路移植术后患者的短期疗效观察[J].中国循环杂志,2017,32(4):318-321.DOI:10.3969/j.issn.1000-3614.2017.04.003.
[9]Russo N,Compostella L,Tarantini G,et al.Cardiac rehabilitation after transcatheter versus surgical prosthetic valve implantation for aortic stenosis in the elderly[J].Eur J Prev Cardiol,2014,21(11):1341-1348.DOI:10.1177/2047487313494029.
[10]Mazzuco A,Medeiros WM,Souza AS,et al.Are heart rate dynamics in the transition from rest to submaximal exercise related to maximal cardiorespiratory responses in COPD?[J].Braz J Phys Ther,2017,21(4):251-258.DOI:10.1016/j.bjpt.2017.05.002.
[11]邵迴龙,梁家立,钟萍,等.运动锻炼对冠状动脉旁路移植术患者心率变异性的影响[J].心血管康复医学杂志,2013,22(1):10-14.DOI:10.3969/j.issn.1008-0074.2013.01.03.
[12]渠林楠,崔玉芳,虞彬.早期康复对经桡动脉行急诊PCI的急性心梗患者左室射血分数及运动耐量的影响[J].实用临床医药杂志,2017,21(8):5-7.DOI:10.7619/jcmp.201708002.
[13]Spiroski D,Andjic M,Stojanovic OI,et al.Very short/short-term benefit of inpatient/outpatient cardiac rehabilitation programs after coronary artery bypass grafting surgery[J].Clin Cardiol,2017,40(5):281-286.DOI:10.1002/clc.22656.
[14]Bisca GW,Camillo CA,Cavalheri V,et al.Peripheral muscle training in patients with chronic obstructive pulmonary disease:novel approaches and recent advances[J].Expert Rev Respir Med,2017,11(5):413-423.DOI:10.1080/17476348.2017.1317598.
[15]许晶晶.心血管疾病的心脏康复[J].中国循环杂志,2013,28(8):635-637.DOI:10.3969/j.issn.1000-3614.2013.08.021.
© 2004-2018 中国地质图书馆版权所有 京ICP备05064691号 京公网安备11010802017129号 地址：北京市海淀区学院路29号 邮编：100083 电话：办公室：(+86 10)66554848；文献借阅、咨询服务、科技查新：66554700 |