Department of Cardiothoracic Surgery, Center for Cardiovascular Research, Aalborg Hospital, Aarhus University Hospital, Hobrovej, postboks 365, DK-9100 Aalborg, Denmark.
Eur J Cardiovasc Nurs. 2010 Jun;9(2):77-84. doi: 10.1016/j.ejcnurse.2009.11.009. Epub 2010 Jan 3.
After midline sternotomy patients are instructed on activity precautions to avoid sternal wound complications. We questioned how restrictive these precautions must be, since they can lead to a postoperative decrease in quality of life.
To identify mechanical stress factors causing sternal instability and infection in order to create evidence based guidelines for activity following sternotomy.
Literature review.
No evidence was found to support weight limitation regarding activity, as long as the upper arms are kept close to the body and activity is within a pain-free range.
Avoid stretching both arms backwards at the same time (10 days); loaded activities should be done with the elbows close to the body (eight weeks); only move arms within a pain-free range; use leg rolling with counterweighing when getting in and out of bed; when coughing cross the arms in a "self-hugging" posture; supportive bra or vest is recommended when breast cup>or=D, body mass index>or=35 or frequent cough.
This study provides insights into mechanical stress factors acting upon sternum and the overlying skin. RECOMMENDATIONS on activity precautions based on these finding have a patient supportive approach focusing on possibilities and not restrictions.
正中胸骨切开术后，患者会被告知活动注意事项，以避免胸骨伤口并发症。我们质疑这些预防措施必须有多么严格，因为它们会导致术后生活质量下降。
确定导致胸骨不稳定和感染的机械应力因素，以便为胸骨切开术后的活动制定基于证据的指南。
文献回顾。
没有证据支持活动时限制上肢的重量，只要保持上肢靠近身体，活动在无痛范围内即可。
避免同时向后伸展双臂（10 天）；进行负重活动时，肘部应靠近身体（8 周）；仅在无痛范围内移动手臂；使用腿部滚动和平衡来上下床；咳嗽时双臂交叉呈“自我拥抱”姿势；推荐使用支撑胸罩或背心，当乳房杯≥D 时，身体质量指数≥35 或经常咳嗽。
本研究深入了解了作用于胸骨和覆盖皮肤的机械应力因素。基于这些发现的活动预防建议采取了以可能性而非限制为重点的患者支持方法。
