加速康复外科干预对高龄心脏瓣膜置换术患者术后康复效果的影响

Effect of enhanced recovery after surgery intervention on postoperative rehabilitation of elderly patients with heart valve replacement

目的分析加速康复外科干预对高龄心脏瓣膜置换术患者术后康复效果和不良事件发生情况的影响。方法选择2015年1月至2019年1月于清华大学第一附属医院行心脏瓣膜置换术的高龄患者70例为研究对象,遵循单盲随机分配原则,采用随机数字表法将其分为试验组和对照组,每组各35例。两组患者由同一组医师进行心脏瓣膜置换术,对照组患者术后接受常规外科干预,试验组患者术后接受加速康复外科干预,本次干预时间截至患者出院前一天。比较两组患者术后首次排气和排便时间、住院天数、不良事件发生率、生存质量评分和康复效果。结果试验组患者术后首次排气和排便时间均显著早于对照组(均P<0.05),住院天数显著短于对照组(P<0.05),术后不良事件发生率显著低于对照组(P<0.05)。干预后,两组患者各项生存质量评分均显著高于本组干预前(均P<0.05);试验组患者生理领域和心理领域评分均显著高于对照组(均P<0.05),环境领域和社会关系领域评分组间比较差异均无统计学意义(均P>0.05)。试验组术后3~4 d可完成床上主动运动、术后8~10 d可自行下床洗漱、术后13~16 d可沿走廊行走200 m患者占比均显著高于对照组(均P<0.05)。结论与常规外科干预相比,加速康复外科干预可在生理领域和心理领域显著提高高龄心脏瓣膜置换术患者术后生存质量,改善患者恢复情况,不良事件发生率低,对提升康复效果具有重要价值。

Objective To research and explore the effect of enhanced recovery after surgery intervention on elderly patients undergoing heart valve replacement,and its impact on postoperative rehabilitation and adverse reactions.Method Seventy elderly patients who underwent heart valve replacement from January 2015 to January 2019 in the First Affiliated Hospital of Tsinghua University were selected as the research subjects.Following the principle of single blind random allocation,they were divided into experimental group and control group by random number table method,35 cases in each group.The two groups of patients were underwent heart valve replacement by the same group of physicians.Control group patients received conventional surgical intervention after surgery.Experimental group patients received enhanced recovery after surgery intervention after surgery.The intervention period ended until the day before patients were discharged.The first exhaust and first defecation after surgery,hospital day,incidence of adverse events and rehabi litation effect were compared between the two groups.Result The time of first exhaust and first defecation after surgery in exper imental group were significantly earlier than those in control group(all P<0.05),the hospital day was significantly shorter than that of control group(P<0.05),the incidence of postoperative adverse events was significantly lower than that of control group(P<0.05).After intervention,the quality of life scores of the two groups of patients were significantly higher than those before interv ention(all P<0.05),the scores of physiological and psychological areas of experimental group were significantly higher than those of control group(all P<0.05).There were no significant differences between the two groups in the scores of environmental field and social relation field(all P>0.05).The proportion of patients who could complete active exercise in bed 3~4 days after surgery,could get out of bed and wash themselves 8~10 days after surgery,and could walk along the corridor for 200 m 13~16 days after surgery were significantly higher than those of control group(all P<0.05).Conclusion Compared with conventional surgical intervention,the intervention of enhanced recovery after surgery applied to elderly patients undergoing heart valve replacement can significantly improve the quality of life and improve the recovery,and the incidence of adverse events is lower,which is of great value for improving the effect of rehabilitation.