一体化管理模式对冠状动脉搭桥术后患者康复效果的研究

Effect of integrated management mode on rehabilitation of patients after coronary artery bypass grafting

目的观察一体化心脏康复管理模式对冠脉搭桥术后患者的有效性。方法选取60例2016年8月至2018年5月在瑞金医院心外科接受冠脉搭桥手术的术后患者,根据患者意愿分为两组:一体化管理组(观察组)30例和对照组30例。两组患者住院期间均接受规范康复治疗,对照组出院后根据医生给出的康复方案自行在家康复治疗,定期门诊随访;观察组出院后由医院的主管医师和患者协商后选择某一社区卫生机构作为其长期实施心脏康复计划的单位,手术医生、康复医生和康复治疗师共同监督心脏康复方案的实施,定期电话随访并上门督促,及时评估,并给予进一步指导。分别于入组后3个月、半年、1年时进行门诊随访,进行活动耐量评估(6min步行试验),整个随访过程中还需记录患者因病情加重而提前就诊或住院治疗的相关不良事件数据。结果观察组和对照组在入组后3个月、半年、1年的6min步行距离均持续改善,且各时间点之间比较有显著统计学差异(P<0.01),但观察组在各时间点改善程度较对照组高,组间比较有显著统计学差异(P<0.01)。观察组和对照组的1年内不良事件发生率组间比较无明显统计学差异(P>0.05)。结论冠脉搭桥术后由手术医生、康复医生和康复治疗师共同监督心脏康复方案实施的一体化心脏康复管理模式对术后快速提高患者的活动能力有肯定的效果,值得进一步推广;但对防止患者术后因心脏原因导致的再入院等不良事件尚未见明确效果,有待后续进一步研究。

Objective To investigate the effect of integrated management mode in patients after coronary artery bypass grafting. Methods A total of 60 patients who underwent coronary artery bypass grafting in Department of Cardiac Surgery, Ruijin Hospital, from August 2016 to May 2018 were enrolled, and according to their will, they were divided into integrated management group(observation group) and control group, with 30 patients in each group. Both groups were given standard rehabilitation treatment during hospitalization;after discharge, the patients in the control group received rehabilitation treatment at home based on the rehabilitation regimen provided by the physician and were followed up regularly at the outpatient service. For the patients in the observation group, a community health service institution was selected by the physician in charge and the patient to perform long-term cardiac rehabilitation, and the implementation of the cardiac rehabilitation regimen was supervised by the surgical physician, the rehabilitation physician, and the rehabilitation therapist;meanwhile, the patients were followed up regularly by telephone and received visits for supervision, timely evaluation, and further guidance. Activity tolerance was evaluated using the six-minute walk test during the outpatient follow-up at 3 months, half a year, and a year after enrollment, and the data on adverse events related to early visit or hospitalization due to exacerbation of disease conditions were also recorded throughout follow-up.Results There was a continuous improvement in six-minute walk distance at 3 months, half a year, and a year after enrollment in both the observation group and the control group, with a significant difference between time points(P <0.01), and the observation group had a significantly greater improvement than the control group at each time point(P<0.01). There was no significant difference in the incidence rate of adverse events within 1 year between the observation group and the control group(P>0.05).Conclusion The integrated management mode in which the implementation of cardiac rehabilitation regimen is supervised by surgical physician, rehabilitation physician, and rehabilitation therapist has a marked effect in improving patients’ activity ability after coronary artery bypass grafting and thus holds promise for further application, while it has no marked effect in preventing adverse events(including readmission) caused by heart issues after surgery, which requires further studies.