早期下床活动对冠状动脉旁路移植术后病人呼吸功能恢复的影响

Effect of early off-bed activity on the respiratory function recovery of patients treated with coronary artery bypass grafting

目的:研究早期下床活动对冠状动脉搭桥术后病人呼吸功能恢复的影响。方法:将符合入选标准的120例冠状动脉搭桥术后病人采用随机分组的方法分成观察组(58例)和对照组(62例),观察组为术后12~24 h下床活动,对照组为术后24~48 h下床活动。根据早期活动纳入标准对病人进行评估,按首次下床活动规范流程分别对2组病人指导进行下床活动,同时2组均按照下床活动计划表进行功能锻炼。比较2组术后1~7 d呼吸功能障碍程度,术后1~7 d的深吸气量,术后第2、4、7天的氧分压及二氧化碳分压,及肺部并发症的发生率。结果:呼吸功能障碍程度术后第1天2组比较差异无统计学意义(P>0.05),术后第2~7天观察组明显低于对照组(P<0.05~P<0.01);深吸气量术后第1~7天观察组高于对照组(P<0.01);氧分压术后第2、4、7天观察组高于对照组(P<0.01);二氧化碳分压术后第4天观察组低于对照组(P<0.01),术后第2、7天2组比较差异均无统计学意义(P>0.05);观察组肺部并发症的发生率低于对照组(P<0.05)。结论:冠状动脉搭桥术后病人早期下床活动是安全可行的,并且下床活动时间越早,肺部并发症的发生率越低,越能促进呼吸功能的恢复。

Objective:To study the effects of early off-bed activities on respiratory function recovery of patients treated with coronary artery bypass grafting(CABG).Methods:One hundred and twenty patients met with the criteria of CABG were randomly divided into the observation group(n=58)and control group(n=62).The time of postoperative off-bed activity in observation group and control group were 12 to 24 hours and 24 to 48 hours,respectively.The patients were evaluated according to the criteria of early activity.Two groups got out of bed activity according to the procedure of the first time of off-bed activity,and performed functional exercises according to the activity schedule.The degree of respiratory dysfunction and deep inspiratory volume after 1 to 7 days of operation,partial pressure of oxygen and CO 2 on the 2nd,4th and 7th day after operation,and incidence rate of pulmonary complications were compared between two groups.Results:The difference of the degree of respiratory dysfunction after 1 day of operation was not statistically significant(P>0.05),and which in observation group at postoperative 2 to 7 days were significantly lower than that in control group(P<0.05 to P<0.01).The deep inspiratory volume in observation group after 1 to 7 days of operation were higher than that in control group(P<0.01).The partial oxygen pressure in observation group on the 2nd,4th and 7th day after operation were higher than that in control group(P<0.01).The partial pressure of CO 2 in observation group on the postoperative 4th day was lower than that in control group(P<0.01),and the differences of partial pressure of CO 2 on the postoperative second and 4th day were not statistically significant between two groups(P>0.05).The incidence rate of pulmonary complications in observation group was lower than that in control group(P<0.05).Conclusions:Early off-bed activity in patients treated with CABG is safe and feasible.The earlier the out-of-bed activity is,the lower the incidence rate of pulmonary complications is,and the better the recovery of respiratory function is.