Ohbe Hiroyuki, Nakamura Kensuke, Uda Kazuaki, Matsui Hiroki, Yasunaga Hideo
Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 1130033, Japan.
Department of Emergency and Critical Care Medicine, Hitachi General Hospital, 2-1-1, Jonantyo, Hitachi, Ibaraki 3170077, Japan.
J Clin Med. 2021 Feb 6;10(4):618. doi: 10.3390/jcm10040618.
It is unclear when to begin rehabilitation after coronary artery bypass grafting (CABG) in the intensive care unit (ICU). Using the Japanese Diagnosis Procedure Combination inpatient database from 2010 to 2018, we identified adult patients who underwent a CABG and who were admitted to the ICU for ≥3 consecutive days from the date of their CABG. Patients who started any rehabilitation program prescribed by physicians or therapists within 3 days of CABG were defined as the early rehabilitation group, and the remaining patients were defined as the usual care group. We identified 30,568 eligible patients, with 13,150 (43%) patients in the early rehabilitation group. An inverse probability of treatment weighting analyses showed that the Barthel Index score at discharge in the early rehabilitation group was significantly higher than that in the usual care group (difference: 3.2; 95% confidence interval: 1.5-4.8). The early rehabilitation group had significantly lower in-hospital mortality, total hospitalization costs, length of ICU stay, and hospital stay vs. the usual care group. Our results suggested that early rehabilitation by physicians or therapists beginning within 3 days of CABG was safe, as suggested by the low mortality and improved physical function in patients who underwent CABG.
在重症监护病房（ICU）中，冠状动脉旁路移植术（CABG）后何时开始康复治疗尚不清楚。利用2010年至2018年日本诊断程序组合住院患者数据库，我们确定了接受CABG且自CABG之日起连续3天及以上入住ICU的成年患者。在CABG后3天内开始由医生或治疗师规定的任何康复计划的患者被定义为早期康复组，其余患者被定义为常规护理组。我们确定了30568名符合条件的患者，其中13150名（43%）患者在早期康复组。逆概率治疗加权分析显示，早期康复组出院时的巴氏指数评分显著高于常规护理组（差异：3.2；95%置信区间：1.5 - 4.8）。与常规护理组相比，早期康复组的院内死亡率、总住院费用、ICU住院时间和住院时间显著更低。我们的结果表明，CABG后3天内由医生或治疗师开始的早期康复是安全的，这体现在接受CABG患者的低死亡率和改善的身体功能上。
