Giardini Marica, Guenzi Marco, Arcolin Ilaria, Godi Marco, Pistono Massimo, Caligari Marco
Istituti Clinici Scientifici Maugeri IRCCS, Division of Physical Medicine and Rehabilitation of Veruno Institute, 28013 Gattico-Veruno, Italy.
Istituti Clinici Scientifici Maugeri IRCCS, Division of Cardiac Rehabilitation of Veruno Institute, 28103 Gattico-Veruno, Italy.
J Clin Med. 2023 Jul 13;12(14):4665. doi: 10.3390/jcm12144665.
Patients with sternotomy are advised to follow sternal precautions to avoid the risk of sternal complications. However, there are no standard recommendations, in particular to perform the supine-to-sitting postural change, where sternal asymmetrical force may be applied. The aim of this study was to compare the rotational movement and the use of a tied rope (individual device for supine-to-sitting, "IDSS") to perform the supine-to-sitting postural change. A total of 92 patients (26% female) admitted to a rehabilitative post-surgery ward with sternotomy were assessed for sternal instability. Levels of pain and perceived effort during the two modalities of postural change and at rest were assessed. Patients reported higher values of pain and perceived effort (both < 0.0005) during rotational movement with respect to the use of the IDSS. Moreover, patients with sternal instability (14%) and female patients with macromastia (25%) reported higher pain than those stable or without macromastia (both < 0.05). No other risk factors were associated with pain. Thus, the IDSS seems to reduce the levels of pain and perceived effort during the supine-to-sitting postural change. Future studies with quantitative assessments are required to suggest the adoption of this technique, mostly in patients with high levels of pain or with sternal instability.
建议行胸骨切开术的患者遵循胸骨保护措施，以避免发生胸骨并发症的风险。然而，目前尚无标准建议，尤其是在进行仰卧位到坐位的体位改变时，可能会施加不对称的胸骨力。本研究的目的是比较旋转运动和使用系绳（仰卧位到坐位的个体装置，“IDSS”）进行仰卧位到坐位体位改变的情况。对92例入住术后康复病房且行胸骨切开术的患者（26%为女性）进行胸骨稳定性评估。评估了两种体位改变方式及休息时的疼痛程度和自觉用力程度。与使用IDSS相比，患者在旋转运动时报告的疼痛值和自觉用力程度更高（均<0.0005）。此外，胸骨不稳定的患者（14%）和患有巨乳症的女性患者（25%）报告的疼痛高于稳定患者或无巨乳症的患者（均<0.05）。没有其他危险因素与疼痛相关。因此，IDSS似乎可以降低仰卧位到坐位体位改变时的疼痛程度和自觉用力程度。需要进行定量评估的未来研究，以建议采用这种技术，尤其是在疼痛程度较高或胸骨不稳定的患者中。
