早期心肺康复在儿童腋下切口心脏手术中的应用
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摘要
目的探讨早期心肺康复在右侧腋下小切口儿童心脏手术后康复中的作用。方法选取笔者医院2015年1月～2016年12月行右侧腋下小切口心脏手术的64例患儿,随机分为对照组和实验组各32例,对照组实施传统心脏术后康复治疗,实验组在对照组基础上实施早期心肺康复治疗,比较两组患者术后WeeFIM评分、机械通气时间、ICU住院时间、术后住院时间、并发症发生率、术后左心室射血分数(LVEF)、用力肺活量(FVC)、第1秒用力呼气量(FEV_1)和6min步行距离(6MWD)。结果两组患者术后机械通气时间、ICU住院时间比较,差异无统计学意义(P>0.05),实验组术后WeeFIM评分、并发症发生率、FEV_1、FVC及6MWD显著好于对照组(P<0.01),术后住院时间、术后LVEF明显好于对照组(P<0.05)。结论对右侧腋下小切口心脏手术患者实施早期心肺康复治疗,可以明显改善患者心肺功能,减少并发症,缩短住院时间。儿童心脏手术后接受早期心肺康复治疗是安全、有效的。
Objective To discuss the effect of early cardiopulmonary rehabilitation therapy in children after cardiac surgery through right subaxillary incision. Methods From January of 2015 to December of 2016, 64 patients undergoing cardiac surgery through right subaxillary incision were randomly divided into two groups: experimental group(n=32) and control group(n=32). The early cardiopulmonary rehabilitation treatment and conventional treatment were implemented respectively for experimental group and control group.After the treatment, the WeeFIM score, mechanical ventilation time,ICU hospitalization time, hospitalization time, the incidence of complications, left ventricular ejection fraction(LVEF), forced vital capacity(FVC),forced expiratory volume in first second(FEV_1),6 minute walking distance(6 MWD) were compared between two groups. Results There were no statistical differences between the two groups in mechanical ventilation time and ICU hospitalization time(P>0.05).The WeeFIM score、FEV1、FVC、6 MWD and LVEF after surgery in experimental group were significantly higher than that in control group(P<0.05), and the incidences of complications and hospitalization time were significantly lower than that in control group(P<0.05).Conclusion It is safe and effective for the children undergoing right subaxillary incision cardiac surgery to accept early cardiopulmonary rehabilitation therapy, which can significantly improve cardiopulmonary function,and reduce the incidence of complications, also shorten the hospitalization time.
Objective To discuss the effect of early cardiopulmonary rehabilitation therapy in children after cardiac surgery through right subaxillary incision. Methods From January of 2015 to December of 2016, 64 patients undergoing cardiac surgery through right subaxillary incision were randomly divided into two groups: experimental group(n=32) and control group(n=32). The early cardiopulmonary rehabilitation treatment and conventional treatment were implemented respectively for experimental group and control group.After the treatment, the WeeFIM score, mechanical ventilation time,ICU hospitalization time, hospitalization time, the incidence of complications, left ventricular ejection fraction(LVEF), forced vital capacity(FVC),forced expiratory volume in first second(FEV_1),6 minute walking distance(6 MWD) were compared between two groups. Results There were no statistical differences between the two groups in mechanical ventilation time and ICU hospitalization time(P>0.05).The WeeFIM score、FEV1、FVC、6 MWD and LVEF after surgery in experimental group were significantly higher than that in control group(P<0.05), and the incidences of complications and hospitalization time were significantly lower than that in control group(P<0.05).Conclusion It is safe and effective for the children undergoing right subaxillary incision cardiac surgery to accept early cardiopulmonary rehabilitation therapy, which can significantly improve cardiopulmonary function,and reduce the incidence of complications, also shorten the hospitalization time.
引文
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11马跃文,朱佳琪,谷天祥,等.心肺康复对冠脉搭桥术后患者肺功能及运动耐力的影响[J].中国康复医学杂志,2013,28(11):1010-1014
12中国康复医学会心血管病专业委员会,中国老年学学会心脑血管病专业委员会.慢性稳定性心力衰竭运动康复中国专家共识[J].中华心血管病杂志,2014,42(9):714-720
13 Keteyian SJ,Pina IL,Hibner BA,et al.Clinical role of exercise training in the management of patients with chronic heart failure[J].Cardiopulm Rehabil Prev,2010,30(2):67-76
14邵峻,何建国,陈涛,等.6分钟步行距离试验评估合并肺动脉高压的先天性心脏病患者手术效果[J].心肺血管病杂志,2010,29(5):385-387
15田宏,朱雪梅,叶明,等.六分钟步行试验对先天性心脏病术后患儿心功能评估的作用[J].中国循证儿科杂志,2012,7(6):440-444
16 Bitter V,Weiner DH,Yusuf S,et al.Predication of mortality and morbidity with a 6-minute walk test in patients with left ventricular dysfunction[J].JAMA,1993,270:1702-1707
17朱默,史惟.儿童功能独立检查量表的研究及应用[J].中国儿童保健杂志,2006,14(5):500-502
2陈文华.心肺康复治疗是改善心肺功能的可靠手段[J].实用老年医学,2013,27(3):179-180
3吴华炼,王勇,黄瑞瑜,等.系统化早期康复运动对ICU机械通气患者肌力及自理能力的干预效果[J].广东医学,2017,38(8):1216-1219
4 Herdy AH,Marcchi PLB,Vila A,et al.Pre-and postoperative cardiopulmonary rehabilitation in hospitalized patients undergoing coronary artery bypass surgery:a randomized controlled trial[J].Am JPhys Med Rehab,2008,87(9):714-719
5郑凯,于克东,李阳.早期康复治疗在心脏手术后的应用[J].现代中西医结合杂志,2007,16(11):1492
6刘艳玲,孙兴国,高华,等.心肺运动指导个体化心衰患者康复的初步总结报告[J].中国应用生理学杂志,2015,31(4):374-377
7 Mendez-Tellez PA,Needham DM.Early physical rehabilitation in the ICU and ventilator liberation[J].Respir Care,2012,57(10):1663-1669
8 Adler J,Malone D.Early mobilization in the intensive care unit:a systematic review[J].Cardiopulm Phys Ther J,2012,23(1):5-13
9 Castro AA,Calil SR,Freitas SA,et al.Chest physiotherapy effectiveness to reduce hospitalization and mechanical ventilation length of stay,pulmonary infection rate and mortality in ICU patients[J].Respir Med,2013,107:68-74
10刘华,刘遂心,张文亮,等.住院期康复治疗对心脏外科手术后患者生存质量和心理状态的影响[J].中国康复医学杂志,2017,32(6):676-680
11马跃文,朱佳琪,谷天祥,等.心肺康复对冠脉搭桥术后患者肺功能及运动耐力的影响[J].中国康复医学杂志,2013,28(11):1010-1014
12中国康复医学会心血管病专业委员会,中国老年学学会心脑血管病专业委员会.慢性稳定性心力衰竭运动康复中国专家共识[J].中华心血管病杂志,2014,42(9):714-720
13 Keteyian SJ,Pina IL,Hibner BA,et al.Clinical role of exercise training in the management of patients with chronic heart failure[J].Cardiopulm Rehabil Prev,2010,30(2):67-76
14邵峻,何建国,陈涛,等.6分钟步行距离试验评估合并肺动脉高压的先天性心脏病患者手术效果[J].心肺血管病杂志,2010,29(5):385-387
15田宏,朱雪梅,叶明,等.六分钟步行试验对先天性心脏病术后患儿心功能评估的作用[J].中国循证儿科杂志,2012,7(6):440-444
16 Bitter V,Weiner DH,Yusuf S,et al.Predication of mortality and morbidity with a 6-minute walk test in patients with left ventricular dysfunction[J].JAMA,1993,270:1702-1707
17朱默,史惟.儿童功能独立检查量表的研究及应用[J].中国儿童保健杂志,2006,14(5):500-502