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新型康复干预措施对冠状动脉旁路移植术后患者身体功能的改善:一项随机对照试验。

Improvement in Physical Function After Coronary Artery Bypass Graft Surgery Using a Novel Rehabilitation Intervention: A RANDOMIZED CONTROLLED TRIAL.

机构信息

Division of Cardiology, Department of Medicine (Messrs Rengo and Savage Drs Ades and Toth) and Division of Cardiothoracic Surgery, Department of Surgery (Drs Hirashima and Leavitt), College of Medicine, The University of Vermont, Burlington.

出版信息

J Cardiopulm Rehabil Prev. 2021 Nov 1;41(6):413-418. doi: 10.1097/HCR.0000000000000576.

Abstract

PURPOSE

Cardiorespiratory and skeletal muscle deconditioning occurs following coronary artery bypass graft surgery and hospitalization. Outpatient, phase 2 cardiac rehabilitation (CR) is designed to remediate this deconditioning but typically does not begin until several weeks following hospital discharge. Although an exercise program between discharge and the start of CR could improve functional recovery, implementation of exercise at this time is complicated by postoperative physical limitations and restrictions. Our objective was to assess the utility of neuromuscular electrical stimulation (NMES) as an adjunct to current rehabilitative care following postsurgical discharge and prior to entry into CR on indices of physical function in patients undergoing coronary artery bypass graft surgery.

METHODS

Patients were randomized to 4 wk of bilateral, NMES (5 d/wk) to their quadriceps muscles or no intervention (control). Physical function testing was performed at hospital discharge and 4 wk post-discharge using the Short Physical Performance Battery and the 6-min walk tests. Data from 37 patients (19 control/18 NMES) who completed the trial were analyzed. The trial was registered at ClinicalTrials.gov (NCT03892460).

RESULTS

Physical function measures improved from discharge to 4 wk post-surgery across our entire cohort (P < .001). Patients randomized to NMES, however, showed greater improvements in 6-min walk test distance and power output compared with controls (P < .01).

CONCLUSION

Our results provide evidence supporting the utility of NMES to accelerate recovery of physical function after coronary artery bypass graft surgery.

摘要

目的

冠状动脉旁路移植术后和住院期间会出现心肺和骨骼肌功能障碍。门诊第二期心脏康复(CR)旨在纠正这种功能障碍,但通常要在出院后数周才开始。尽管在出院和开始 CR 之间进行锻炼计划可以改善功能恢复,但此时由于术后身体限制和限制,实施锻炼很复杂。我们的目的是评估神经肌肉电刺激(NMES)作为手术后出院后和进入 CR 之前辅助当前康复护理的一种手段,对接受冠状动脉旁路移植术的患者的身体功能指标的效用。

方法

将患者随机分为 4 周的双侧 NMES(每周 5 天)到股四头肌或无干预(对照组)。在出院时和出院后 4 周使用短体机能测试和 6 分钟步行测试进行身体功能测试。分析了完成试验的 37 名患者(19 名对照组/18 名 NMES 组)的数据。该试验在 ClinicalTrials.gov(NCT03892460)上注册。

结果

整个队列的身体功能测量值从出院到手术后 4 周都有所改善(P <.001)。然而,与对照组相比,接受 NMES 治疗的患者在 6 分钟步行测试距离和功率输出方面的改善更大(P <.01)。

结论

我们的结果为 NMES 在加速冠状动脉旁路移植术后身体功能恢复方面的有效性提供了证据。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/257d/8310525/ecd0e5c645a9/nihms-1647281-f0001.jpg

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