心脏手术后首次离床活动的启动 - 瑞典的一项观察性横断面研究。

First initiation of mobilization out of bed after cardiac surgery - an observational cross-sectional study in Sweden.

机构信息

University Health Care Research Center, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.

Department of Health and Rehabilitation/Physiotherapy, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.

出版信息

J Cardiothorac Surg. 2024 Jul 4;19(1):420. doi: 10.1186/s13019-024-02915-4.

DOI:10.1186/s13019-024-02915-4

PMID:38961385

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11223441/

Abstract

BACKGROUND

Cardiac surgery is associated with a period of postoperative bed rest. Although early mobilization is a vital component of postoperative care, for preventing complications and enhancing physical recovery, there is limited data on routine practices and optimal strategies for early mobilization after cardiac surgery. The aim of the study was to define the timing for the first initiation of out of bed mobilization after cardiac surgery and to describe the type of mobilization performed.

METHODS

In this observational study, the first mobilization out of bed was studied in a subset of adult cardiac surgery patients (n = 290) from five of the eight university hospitals performing cardiothoracic surgery in Sweden. Over a five-week period, patients were evaluated for mobilization routines within the initial 24 h after cardiac surgery. Data on the timing of the first mobilization after the end of surgery, as well as the duration and type of mobilization, were documented. Additionally, information on patient characteristics, anesthesia, and surgery was collected.

RESULTS

A total of 277 patients (96%) were mobilized out of bed within the first 24 h, and 39% of these patients were mobilized within 6 h after surgery. The time to first mobilization after the end of surgery was 8.7 ± 5.5 h; median of 7.1 [4.5-13.1] hours, with no significant differences between coronary artery bypass grafting, valve surgery, aortic surgery or other procedures (p = 0.156). First mobilization session lasted 20 ± 41 min with median of 10 [1-11]. Various kinds of first-time mobilization, including sitting on the edge of the bed, standing, and sitting in a chair, were revealed. A moderate association was found between longer intubation time and later first mobilization (ρ = 0.487, p < 0.001). Additionally, there was a moderate correlation between the first timing of mobilization duration of the first mobilization session (ρ = 0.315, p < 0.001).

CONCLUSIONS

This study demonstrates a median time to first mobilization out of bed of 7 h after cardiac surgery. A moderate correlation was observed between earlier timing of mobilization and shorter duration of the mobilization session. Future research should explore reasons for delayed mobilization and investigate whether earlier mobilization correlates with clinical benefits.

TRIAL REGISTRATION

FoU in VGR (Id 275,357) and Clinical Trials (NCT04729634).

摘要

背景

心脏手术伴随着术后卧床休息的一段时间。尽管早期活动是术后护理的重要组成部分，可预防并发症并促进身体康复，但关于心脏手术后早期活动的常规做法和最佳策略的数据有限。本研究的目的是确定心脏手术后首次下床活动的开始时间，并描述所进行的活动类型。

方法

在这项观察性研究中，从瑞典 8 家进行心胸外科手术的大学医院中的 5 家选择了 290 名成年心脏手术患者的亚组，研究了手术后 24 小时内首次下床活动的时机。在五周的时间内，评估了患者在心脏手术后最初 24 小时内的活动常规。记录了手术结束后首次下床活动的时间、活动的持续时间和类型，以及患者特征、麻醉和手术信息。

结果

共有 277 名（96%）患者在 24 小时内下床活动，其中 39%的患者在手术后 6 小时内下床活动。手术结束后首次下床活动的时间为 8.7±5.5 小时；中位数为 7.1[4.5-13.1]小时，冠状动脉旁路移植术、瓣膜手术、主动脉手术或其他手术之间无显著差异（p=0.156）。第一次活动的持续时间为 20±41 分钟，中位数为 10[1-11]分钟。发现了各种初次活动，包括坐在床边、站立和坐在椅子上。发现插管时间较长与首次活动时间较晚之间存在中度相关性（ρ=0.487，p<0.001）。此外，首次活动的开始时间与首次活动持续时间之间存在中度相关性（ρ=0.315，p<0.001）。