Takahashi Tetsuya, Watanabe Hidetaka, Mochizuki Masamichi, Kikuchi Yuta, Kitahara Eriko, Yokoyama-Nishitani Miho, Morisawa Tomoyuki, Saitoh Masakazu, Iwatsu Kotaro, Minamino Tohru, Tabata Minoru, Fujiwara Toshiyuki, Daida Hiroyuki
Department of Physical Therapy, Faculty of Health Science, Juntendo University, Tokyo, Japan; Department of Rehabilitation, Juntendo University Hospital, Tokyo, Japan; Juntendo University Graduate School of Health Science, Tokyo, Japan.
Department of Rehabilitation, Juntendo University Hospital, Tokyo, Japan.
J Cardiol. 2024 Dec;84(6):366-371. doi: 10.1016/j.jjcc.2024.05.008. Epub 2024 Jun 3.
The purpose of this study was to examine the relationship between responsiveness to prehabilitation and postoperative recovery of physical function in cardiac surgery patients.
Ninety-three cardiac surgery patients (mean age: 76.4 years) were included in this retrospective cohort study. Preoperative physical function was measured using the Short Physical Performance Battery (SPPB), and a prehabilitation exercise program was implemented for the SPPB domains with low scores. Among the patients, those whose SPPB score was over 11 from the start of prehabilitation and remained over 11 on the day before surgery were defined as the high-functioning group, and those whose SPPB score improved by 2 points or more from the start of prehabilitation and exceeded 11 points were defined as the responder group. Those whose SPPB score did not exceed 11 immediately before surgery were classified as non-responders. The characteristics of each group and postoperative recovery of physical function were investigated.
There were no serious adverse events during prehabilitation. Mean days of prehabilitation was 5.4 days. The responder group showed faster improvement in postoperative physical function and shorter time to ambulatory independence than the non-responder group. The non-responder group had lower preoperative skeletal muscle index, more severe preoperative New York Heart Association classification, and a history of musculoskeletal disease or stroke.
There were responders and non-responders to prehabilitation among cardiac surgery patients. Cardiac surgery patients who respond to prehabilitation had faster recovery of physical function. Further research is needed to determine what type of prehabilitation is more effective in postoperative recovery of physical function in cardiac surgery patients.
本研究旨在探讨心脏手术患者对术前康复训练的反应性与术后身体功能恢复之间的关系。
本回顾性队列研究纳入了93例心脏手术患者（平均年龄：76.4岁）。使用简短体能状况量表（SPPB）测量术前身体功能，并针对得分较低的SPPB领域实施术前康复训练计划。在这些患者中，从术前康复训练开始SPPB评分超过11分且在手术前一天仍超过11分的患者被定义为高功能组，从术前康复训练开始SPPB评分提高2分或更多且超过11分的患者被定义为反应者组。手术前SPPB评分未超过11分的患者被归类为无反应者。研究了每组的特征以及术后身体功能的恢复情况。
术前康复训练期间未发生严重不良事件。术前康复训练的平均天数为5.4天。与无反应者组相比，反应者组术后身体功能改善更快，达到独立行走的时间更短。无反应者组术前骨骼肌指数较低，术前纽约心脏协会分级更严重，且有肌肉骨骼疾病或中风病史。
心脏手术患者中存在术前康复训练的反应者和无反应者。对术前康复训练有反应的心脏手术患者身体功能恢复更快。需要进一步研究以确定哪种类型的术前康复训练对心脏手术患者术后身体功能恢复更有效。
