Ⅰ期心肺康复对冠状动脉旁路移植术后患者机体恢复的影响研究

The effect of phase-one cardiopulmonary rehabilitation on the recovery of patients after coronary artery bypass grafting

目的:分析Ⅰ期心肺康复对冠状动脉旁路移植(coronary artery bypass grafting,CABG)术后患者心功能、肺功能、运动能力以及生活质量的改善效果。方法:选取2016年1月1日至2017年12月31日于我院心脏外科行CABG术的患者300例,按随机数字表法分为康复组和对照组各150例。对照组行心脏外科常规治疗,康复组在对照组治疗基础上进行为期2周Ⅰ期(入院第1~14天)心肺康复。比较2组患者干预前后心功能、6 min步行距离(6 minutes walk distance,6MWD)、健康调查简表(MOS 36-item short from health survey,SF-36)得分情况及术后低氧血症、肺部感染等肺部并发症发生率、住院天数等指标差异。结果:干预后,2组患者在每搏输出量(stroke volume,SV)、左心室射血分数(left ventricle ejection fraction,LVEF)、左心室舒张末期容积(left ventricular end-diastolic volume,LVEDV)、6MWD、肺部感染及低氧血症发生率、SF-36中生理机能(physical functioning,PF)、情感职能(role emotional,RE)、一般健康状况(general health,GH)3个维度的得分康复组优于对照组(均P<0.05)。总住院及胸引流管引流天数康复组较对照组短(均P<0.05)。结论:Ⅰ期心肺康复不但提高患者心脏泵血能力及运动耐力,缩短总住院及胸引管引流天数、降低术后肺部感染及低氧血症等呼吸系统并发症发生率,还可降低焦虑及抑郁等负面情绪,改善生活质量。

Objective To evaluate the effect of phase-one cardiopulmonary rehabilitation on the improvement of cardiopulmonary function,exercise capacity and quality of life in patients after coronary artery bypass grafting(CABG).Methods A total of 300 patients undergoing CABG in cardiac surgery of our hospital were enrolled from 1 January 2016 through 31 December 2017.They were randomly divided into rehabilitation group(n=150)and control group(n=150).Besides routine treatments received after cardiac surgery,the rehabilitation group was also placed on phase-one cardiopulmonary rehabilitation intervention for 2 weeks(1-14 days after admission).The cardiac function,six-minute walking distance(6MWD),the MOS item short from health survey(SF-36)health scale scores,postoperative hypoxemia,pulmonary infection,pulmonary complications,and length of hospitalization were compared between the two groups.Results The stroke volume(SV)、left ventricular ejection fraction(LVEF)、left ventricular end-diastolic volume(LVEDV)、6MWD in rehabilitation group were significantly higher in patients treated with phase-one cardiopulmonary rehabilitation(all P<0.05);in the meantime,incidence of pulmonary infection and hypoxemia were lower,while the scores of physical functioning(PF),role emotional(RE)and mental health(MH)were higher in the rehabilitation group(P<0.05).Compared with rehabilitation group,the patients in control group had extended hospital stay and were kept on chest drainage for longer time(all P<0.05).Conclusions Phase-one cardiopulmonary rehabilitation not only improves the patient’s cardiac pumping capacity and exercise endurance,shortens the total number of days of hospitalization and chest drainage.Also with reduced incidence of respiratory complications such as postoperative pulmonary infections and hypoxemia,and lowered anxiety and depression,the treatment greatly improves the patients’quality of life.