Department of Physiotherapy, Sakakibara Heart Institute, Tokyo, Japan.
J Cardiol. 2013 Apr;61(4):299-303. doi: 10.1016/j.jjcc.2012.12.014. Epub 2013 Mar 14.
The aim of this multicenter study was to evaluate the relationship between preoperative kidney function, postoperative acute kidney injury (AKI), and postoperative fluid balance (POFB) with the progress of early postoperative cardiac rehabilitation (CR) in patients undergoing isolated cardiac surgery.
Four hundred twenty three consecutive patients (137 females, 286 males, aged 66±13 years) who underwent various elective cardiac surgeries in the participating institutes were selected and divided into 5 groups depending on chronic kidney disease (CKD) stage. We evaluated the effects of CKD stage on the progress of early postoperative CR, and analyzed the factors determining the achievement of Japanese Circulation Society (JCS) early postoperative CR guidelines goal.
Initiation of sitting (F=7.59, p<0.01) and standing (F=4.83, p<0.01), walking (F=4.40, p<0.01), and 100-m unassisted walk (F=13.09, p<0.01) were related with severity of preoperative CKD stage. The proportion of patients who could not achieve JCS early postoperative CR guideline goal was 15.0% in patients with CKD and 12.9% in patients without CKD. Multivariable analyses identified Risk, Injury, Failure, Loss, and End-stage Kidney (RIFLE) classification (of postoperative AKI) and blood urea nitrogen as factors determining achievement of early postoperative CR goal in patients with CKD; and POFB/preoperative body weight (PBW), RIFLE classification as determinants in patients without CKD. Using the receiver-operating characteristics curve analysis to predict achievement of the early postoperative CR goal, POFB/PBW 4.9% was identified as the cut-off value for achievement of the JCS early postoperative CR guideline goal.
Preoperative CKD stage correlated significantly with the progress of early postoperative CR after cardiac surgery. Independent determinants of achieving JCS early postoperative CR guideline goal were postoperative AKI in patients with or without CKD, and POFB/PBW only in patients without CKD.
本多中心研究旨在评估术前肾功能、术后急性肾损伤 (AKI) 和术后液体平衡 (POFB) 与接受择期心脏手术的患者术后早期心脏康复 (CR) 进展之间的关系。
选择了在参与研究所接受各种择期心脏手术的 423 例连续患者（女性 137 例，男性 286 例，年龄 66±13 岁），并根据慢性肾脏病 (CKD) 分期分为 5 组。我们评估了 CKD 分期对术后早期 CR 进展的影响，并分析了确定达到日本循环学会 (JCS) 术后早期 CR 指南目标的因素。
坐起（F=7.59，p<0.01）和站立（F=4.83，p<0.01）、行走（F=4.40，p<0.01）和 100 米无辅助行走（F=13.09，p<0.01）的开始与术前 CKD 分期的严重程度有关。不能达到 JCS 术后早期 CR 指南目标的患者比例在 CKD 患者中为 15.0%，在无 CKD 患者中为 12.9%。多变量分析确定了术后 AKI 的风险、损伤、衰竭、损失和终末期肾脏（RIFLE）分类以及血尿素氮是 CKD 患者达到术后早期 CR 目标的决定因素；而 POFB/术前体重（PBW）、RIFLE 分类是无 CKD 患者的决定因素。使用受试者工作特征曲线分析预测达到术后早期 CR 目标，发现 POFB/PBW4.9%是达到 JCS 术后早期 CR 指南目标的截止值。
术前 CKD 分期与心脏手术后术后早期 CR 的进展显著相关。达到 JCS 术后早期 CR 指南目标的独立决定因素是 CKD 患者的术后 AKI 和无 CKD 患者的 POFB/PBW。
