Department of Medical Rehabilitation and Clinical Physiotherapy, Pomeranian Medical University in Szczecin, ul. Żołnierska 54, 70-204 Szczecin, Poland.
Department of Cardiac Surgery, Pomeranian Medical University in Szczecin, al. Powstańców Wlkp. 72, 70-111 Szczecin, Poland.
Int J Environ Res Public Health. 2018 Nov 17;15(11):2572. doi: 10.3390/ijerph15112572.
: Intensive post-operative physiotherapy after cardiac surgery helps to reduce the number of complications, accelerating convalescence and decreasing peri-operative mortality. Cardiac rehabilitation is aimed at regaining lost function and sustaining the effect of cardiac surgery. The aim of this study was to compare the efficacy of inpatient and home-based phase II physiotherapy following coronary artery bypass grafting, and inpatient phase II post-operative physiotherapy based on the analysis of the spirometry results. : A prospective observational study included 104 adult patients of both sexes undergoing planned coronary artery bypass grafting and were randomized to one of the two groups-inpatients (InPhysio) and home-based (HomePhysio) at a 1:1 ratio. All patients had undergone spirometry testing prior to surgery (S1) and on the fifth day after the operation (S2), i.e., on the day of completion of the first phase (PI) of physiotherapy. Both the study group (InPhysio) and the control group (HomePhysio) performed the same set of exercises in the second phase (PII) of cardiac physiotherapy, either in the hospital or at home, respectively, according to the program obtained in the hospital. Both groups have undergone spirometry testing (S3) at 30 days after the operation. : The demographic and peri-operative data for both groups were comparable and showed no statistically significant differences. An analysis of gradients between the results of spirometry tests before surgery and at 30 days after the surgery showed a smaller decrease in forced vital capacity (FVC) in the study group than in the control group ( < 0.001). The results at five and 30 days after the surgery showed a greater increase in FVC in the study group than in the control group (680 mL vs. 450 mL, = 0.009). There were no statistically significant differences in other parameters studied. : The advantage of inpatient over home-based physiotherapy was evidenced by much smaller decreases in FVC between the initial and final tests, and greater increases between the fifth day after surgery and the final test. Our analysis showed greater efficacy of inpatient physiotherapy as compared with home-based exercises and raises concerns about patient adherence.
术后强化理疗有助于减少心脏手术后的并发症，加速康复，降低围手术期死亡率。心脏康复旨在恢复丧失的功能并维持心脏手术的效果。本研究旨在比较冠状动脉旁路移植术后住院期和家庭期 II 期物理治疗的疗效，并基于肺功能检查结果分析住院期 II 期术后物理治疗的效果。
一项前瞻性观察性研究纳入了 104 名接受计划性冠状动脉旁路移植术的成年男女患者，按 1:1 比例随机分为两组，住院组（InPhysio）和家庭组（HomePhysio）。所有患者均在术前（S1）和术后第 5 天（S2），即第一阶段（PI）物理治疗完成的当天进行了肺功能检查。在第二阶段（PII）心脏物理治疗中，研究组（InPhysio）和对照组（HomePhysio）均根据在医院获得的方案在家中或医院分别进行相同的一组运动。两组均在术后 30 天进行了肺功能检查（S3）。
两组的人口统计学和围手术期数据相似，无统计学差异。对术前和术后 30 天肺功能检查结果的梯度分析显示，研究组用力肺活量（FVC）的下降幅度小于对照组（<0.001）。术后第 5 天和 30 天的结果显示，研究组 FVC 的增加幅度大于对照组（680mL 比 450mL，=0.009）。其他研究参数无统计学差异。
与家庭期物理治疗相比，住院期物理治疗的优势在于初始和最终测试之间 FVC 的下降幅度较小，以及术后第 5 天和最终测试之间的增加幅度较大。我们的分析表明，住院期物理治疗的效果优于家庭期运动治疗，并对患者的依从性提出了担忧。
