高龄老年患者起搏器植入术出院后肩关节主动活动时间与肩周炎发生率的相关性研究

Study for the correlation between active time of shoulder joint movement and incidence of periarthritis of shoulder for discharged elderly patients after pacemaker implantation

目的 了解高龄老年患者起搏器植入术出院后肩关节主动活动时间与肩周炎发生率的相关关系。方法回顾调查233例于本科室接受起搏器植入的患者,纳入本研究患者143例,根据患者出院后开始主动活动肩关节的时间,分为早期活动组（出院3d内开始主动活动）、中期活动（出院后4~7d开始主动活动）以及延期活动组（出院7d以后才开始主动活动）,三组患者的年龄、性别以及术后卧床时间差异均无统计学意义（P〉0.05）。结果总计17例（11.89%）患者出现肩关节疼痛,早期、中期和延期活动组出现肩关节疼痛的患者分别为2例（4.4%）、5例（10.0%）和10例（21.3%）（P=0.039）,其疼痛的平均持续时间分别为（3.00±1.41）、（5.60±0.89）和（12.88±6.92）周（P=0.037）。总计18例（12.59%）患者出现肩关节活动受限,三组出现该现象的患者例数分别为3（6.7%）、6（12.0%）和9（19.1%）（P=0.195）,其活动受限持续时间分别为（3.33±1.53）周、（7.67±1.50）周和（13.38±5.85）周（P=0.013）,三组均未出现囊袋出血需要清创或切口裂开等并发症。结论 对高龄老年患者起搏器植入术后越早进行肩关节康复训练,则肩周炎发生率越低,疼痛时间越短,并且肩关节早期康复并不增加囊袋血肿、切口裂开和电极脱位及电极断裂的概率。

Objective To understand the correlation between active time of shoulder joint movement and incidence of periarthritis of shoulder for discharged elderly patients after pacemaker implantation. Method A retrospective study was made on 233 patients who received pacemaker implantation in our university, and 143 patients were enrolled in this study, According to the active shoulder movement time for patients after discharge, the patients was divided into early activity group （within three days out of the hospital began to active activity）, medium-term activity groups （4 to 7 days after discharge to active activity）, and extension activities group（discharged 7 days later began to take the initiative to shoulder joint activity）. The patients＇ age, gender, and post-operative bed time for the three group were no statistically significant difference （P 〉 0.05）. Results A total of 17 （11.89% ）patients was shoulder joint pain. The patients with shoulder joint pain for early, mid and extension activities group was 2（4.4%）, 5（10.0%） and 10（21.3%）respectively （P = 0. 039）. The average duration of pain were（3.00±1.41）,（5.60±0.89）and（0.89± 6.92） weeks （P = 0. 037）. A total of 18 patients （12.59 % ）developed shoulder joint activity limitations, patients in three groups appear the phenomenon was 3（6.7%）, 6（12.0%） and 9（19.1%）respectively （P = 0. 195）. The limited activity duration were（3.33±1.53）,（7.67 ±1. 50）and（1.50 ±5.85）weeks （P = 0.013）. Two groups did not appear pouch complications such as bleeding need debridement or incision dehiscence. Conclusion The sooner after pacemaker implantation in patients with older bodies to carry on the shoulder joint rehabilitation training, the lower the incidence of periarthritis of shoulder, the shorter the time pain. Early rehabilitation and shoulder joint did not increase the pouch hematoma, incision dehiscence and electrode and electrode dislocation, fracture probability.