早期康复对起搏器植入术后患者效果及安全性评价

Evaluation of the Effect and Safety of Early Rehabilitation in Patients with Cardiac Pacemaker Implantation

目的探讨早期康复对心脏起搏器植入术后患者生活质量、肩关节并发症及电极脱位事件发生的影响。方法选取2013—2015年绍兴市人民医院心内科行心脏永久起搏器植入术患者220例为研究对象。根据住院时间顺序编号,偶数为早期康复组(110例),奇数为传统治疗组(110例)。传统治疗组患者接受常规康复措施,早期康复组患者从术后6h开始由专人按照不同的程序、循序渐进的功能锻炼进行术后康复干预,术后12 h可下床活动。于术后两周、3个月时,采用SF-36评价患者生活质量,肩关节疼痛和功能障碍指数(SPADI)评价患者可能存在的肩关节疼痛、活动障碍情况,通过X线片评估电极脱位事件。结果早期康复组术后两周SF-36生理功能、生理职能、躯体疼痛、总体健康、活力、社会功能、情感职能、心理健康、躯体健康总评及心理健康总评得分均高于传统治疗组(P<0.05)。早期康复组术后3个月生理功能、生理职能、躯体疼痛、总体健康、社会功能、情感职能、心理健康、躯体健康总评及心理健康总评得分均高于传统治疗组(P<0.05)。两组术后两周SPADI比较,差异无统计学意义(P>0.05);早期康复组术后3个月SPADI低于传统治疗组(P<0.05)。两组术后两周及术后3个月电极脱位事件发生率比较,差异均无统计学意义(P>0.05)。结论与传统治疗相比,起搏器植入术后6h开始进行早期康复干预更有利于提高患者生活质量,降低肩关节疼痛和活动障碍,且并不增加电极脱位事件的发生。

Objective To investigate the effect of early rehabilitation on quality of life,shoulder joint complications and electrode dislocation events in patients with cardiac pacemaker implantation. Methods From 2013 to 2015,a total of 220 patients accepted permanent pacemaker implantation in Department of Cardiology,Shaoxing People＇ s Hospital were selected as study subjects. The patients were numbered according to the order of hospitalization time, the even numbers were early rehabilitation group（ n = 110）,the odd numbers were traditional treatment group（ n = 110）. The patients in the traditional treatment group received routine rehabilitation program. The patients in early rehabilitation group were carried out the rehabilitation intervention by special personnel in accordance with different procedures and step-by-step functional exercise.After 12 h,the patients could get out of bed and exercise. After two weeks and 3 months postoperatively,the patients＇ quality of life was evaluated by SF-36,the patients＇ possible shoulder pain and motion disturbances were assessed by shoulder pain and disability index（ SPADI）,the electrode dislocation events were evaluated by X radiography. Results The scores of physical functioning,role-physical, bodily pain, general health, vitality, social functioning, role-emotional, mental health,physical component summary and mental component summary in the early rehabilitation group were higher than those in the traditional treatment group after two weeks postoperatively（ P〈0. 05）. The scores of physical functioning, role-physical,bodily pain,general health,social functioning, role-emotional, mental health,physical component summary and mental component summary in the early rehabilitation group were higher than those in the traditional treatment group after three months postoperatively（ P〈0. 05）. There was no significant difference in SPADI between the two groups after two weeks postoperatively（ P〈0. 05）. The SPADI of the early rehabilitation group was lower than that of the traditional treatment group after three months postoperatively（ P〈0. 05）. There were no significant differences between the two groups in the incidence of electrode dislocation after two weeks and three months postoperatively（ P〈0. 05）. Conclusion Compared with traditional treatment,early rehabilitation intervention 6h after pacemaker implantation is more beneficial to improve the patients＇ quality of life,reduce shoulder pain and joint movement disorder,and does not increase the incidence of electrode dislocation events.