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一种新型定量一期运动对体外循环术后患者的安全性和有效性:一项单盲、前瞻性、非随机研究。

Safety and efficacy of a novel quantitative phase I exercise in patients after cardiopulmonary bypass: a single-blind, prospective, non-randomized study.

作者信息

Yang Yang, Jin Yan, Chen Cheng, Zheng Qingwan, Ge Min, Wang Lei, Wang Ya-Peng

机构信息

Department of Rehabilitation Medicine, Nanjing Drum Tower Hospital, Clinical College of Nanjing University of Chinese Medicine, Nanjing, China.

Department of Rehabilitation, College of Acupuncture and Moxibustion and Massage Health Preservation and Rehabilitation, Nanjing University of Chinese Medicine, Nanjing, China.

出版信息

J Thorac Dis. 2024 Oct 31;16(10):6565-6578. doi: 10.21037/jtd-24-753. Epub 2024 Oct 30.


DOI:10.21037/jtd-24-753
PMID:39552904
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11565311/
Abstract

BACKGROUND: Despite the positive effect of early post-cardiac surgery exercises, the concern of safety issues is high, indicating the need for standardized and quantitative mobility indicators to enhance early mobilization monitoring in the intensive care unit while ensuring patient safety. This study aimed to compare the safety and efficacy of quantitative phase I exercise versus usual care in patients who have undergone cardiac surgery. METHODS: In this non-randomized, single-blind trial, patients following on-pump cardiac surgery were allocated to either quantitative exercise (intervention group, n=114) or usual care (control group, n=114) based on their willingness. Continuous cycling ergometer was used for intervention, and the peak power was recorded for setting next exercise intensity. Noninvasive cardiac output monitoring during exercise was used for safety management. Patients received one time per day, seven sessions in total. RESULTS: Two-way repeated-measure analysis of variance demonstrated significant group and test time difference for forced expiratory volume in 1 s (FEV1) (P=0.01), maximum expiratory pressure (MEP) (P=0.02), peak expiratory flow (PEF) rate (P=0.045), and 6-minute walking distance (6MWD) (P=0.001); more improvement of 6MWD in intervention group (P<0.001). Intervention group showed significant post-test improvements except FEV1/forced vital capacity (FVC). Post-test differences between groups were observed in FEV1 (P=0.02), FVC (P=0.02), MEP (P=0.02), 6MWD (P<0.001), and △6MWD (P<0.001). Analysis of covariance with smoking as covariate showed consistent results. Postoperative stay in intensive-care unit in the intervention group [mean ± standard deviation (SD), 3.0±1.3] was shorter than that in the control group (mean ± SD, 3.5±2.2) (P=0.03). CONCLUSIONS: Quantitative phase I exercise applied to patients following cardiopulmonary bypass is safe and recovers respiratory and physical capacity more quickly.

摘要

背景:尽管心脏手术后早期运动有积极作用,但对安全问题的担忧依然很高,这表明需要标准化和定量的活动指标,以在确保患者安全的同时加强重症监护病房的早期活动监测。本研究旨在比较定量一期运动与常规护理对心脏手术患者的安全性和有效性。 方法:在这项非随机、单盲试验中,接受体外循环心脏手术的患者根据其意愿被分配到定量运动组(干预组,n = 114)或常规护理组(对照组,n = 114)。使用连续循环测力计进行干预,并记录峰值功率以设定下一次运动强度。运动期间采用无创心输出量监测进行安全管理。患者每天接受一次,共七次。 结果:双向重复测量方差分析显示,1秒用力呼气量(FEV1)(P = 0.01)、最大呼气压力(MEP)(P = 0.02)、呼气峰值流速(PEF)率(P = 0.045)和6分钟步行距离(6MWD)(P = 0.001)存在显著的组间和测试时间差异;干预组的6MWD改善更明显(P < 0.001)。除FEV1/用力肺活量(FVC)外,干预组在测试后均有显著改善。两组在测试后的FEV1(P = 0.02)、FVC(P = 0.02)、MEP(P = 0.02)、6MWD(P < 0.001)和△6MWD(P < 0.001)方面存在差异。以吸烟为协变量的协方差分析显示结果一致。干预组在重症监护病房的术后住院时间[平均值±标准差(SD),3.0±1.3]短于对照组(平均值±SD,3.5±2.2)(P = 0.03)。 结论:应用于体外循环后患者的定量一期运动是安全的,并且能更快地恢复呼吸和身体能力。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/ab9a/11565311/e569620f8cfb/jtd-16-10-6565-f1.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/ab9a/11565311/e569620f8cfb/jtd-16-10-6565-f1.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/ab9a/11565311/e569620f8cfb/jtd-16-10-6565-f1.jpg

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本文引用的文献

[1]
Preoperative respiratory muscle training combined with aerobic exercise improves respiratory vital capacity and daily life activity following surgical treatment for myasthenia gravis.

J Cardiothorac Surg. 2023-4-24

[2]
JCS/JACR 2021 Guideline on Rehabilitation in Patients With Cardiovascular Disease.

Circ J. 2022-12-23

[3]
Guidelines on enhanced recovery after cardiac surgery under cardiopulmonary bypass or off-pump.

Anaesth Crit Care Pain Med. 2022-6

[4]
Nurse-guided incentive spirometry use and postoperative pulmonary complications among cardiac surgery patients: A randomized controlled trial.

Int J Nurs Pract. 2022-4

[5]
The Effect of Pulmonary Rehabilitation on Respiratory Functions, and the Quality of Life, following Coronary Artery Bypass Grafting: A Randomised Controlled Study.

Biomed Res Int. 2021

[6]
The experiences of cardiac surgery critical care clinicians with in-bed cycling in adult patients undergoing complex cardiac surgery.

Disabil Rehabil. 2022-9

[7]
Risk factors for postoperative pneumonia after cardiac surgery: a prediction model.

J Thorac Dis. 2021-4

[8]
The impact of additional resistance and balance training in exercise-based cardiac rehabilitation in older patients after valve surgery or intervention: randomized control trial.

BMC Geriatr. 2021-1-7

[9]
Functional electrical stimulation in-bed cycle ergometry in mechanically ventilated patients: a multicentre randomised controlled trial.

Thorax. 2021-7

[10]
Standardisation, multi-measure, data quality and trending: A qualitative study on multidisciplinary perspectives to improve intensive care early mobility monitoring.

Intensive Crit Care Nurs. 2021-4

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