三联预康复方案在老年心脏瓣膜置换手术患者围手术期的应用  

Effects of trimodal pre-rehabilitation program on older patients undergoing cardiac valve replacement during perioperative period

作　　者：罗桂荣 何银连 林珊珊 李燕飞[1] 罗世官[1] 陈宏明[1] 祝春 吕辉[4] 覃燕兰 黄恒炯[3] 罗前颖[4] LUO Guirong;HE Yinlian;LIN Shanshan;LI Yanfei;LUO Shiguan;CHEN Hongming;ZHU Chun;LYU Hui;QIN Yanlan;HUANG Hengjiong;LUO Qianying(Department of Cardiothoracic and Vascular Surgery,The Affiliated Hospital of Youjiang Medical College for Nationalities,Baise,the Guangxi Zhuang Autonomous Region,533000,China)

机构地区：[1]右江民族医学院附属医院心胸血管外科,广西壮族自治区百色市533000 [2]右江民族医学院附属医院营养科,广西壮族自治区百色市533000 [3]右江民族医学院附属医院康复医学科,广西壮族自治区百色市533000 [4]右江民族医学院护理学院

出　　处：《中国护理管理》2023年第11期1673-1680,共8页Chinese Nursing Management

基　　金：右江民族医学院附属医院2020年度高层次人才科研项目(R202011713);百色市科学研究与技术开发计划项目(百科20202522)。

摘　　要：目的:评价三联预康复方案在老年心脏瓣膜置换手术患者围手术期的临床应用效果,以期为临床提供参考。方法:2021年11月至2022年11月,便利选取百色市某三级甲等医院心胸血管外科择期行心脏瓣膜置换的40例老年患者作为研究对象,按照入院时间先后顺序分为对照组和预康复组,每组20例。对照组给予常规护理,预康复组在常规护理的基础上增加三联预康复方案。比较两组患者入院24 h、手术前1天和出院前1天的6分钟步行试验结果、血清前白蛋白和血清白蛋白水平、焦虑和抑郁评分;比较两组患者呼吸机使用时间、下床活动时间及住院时间、术后部分常见并发症(包括肺部感染、急性肾功能衰竭)及二次气管插管发生率。结果:实施预康复后,手术前1天和出院前1天预康复组患者的6分钟步行试验结果、血清前白蛋白水平、血清白蛋白水平、焦虑评分、抑郁评分明显优于对照组,差异有统计学意义(P<0.05);预康复组患者的术后呼吸机使用时间、下床活动时间及住院时间均明显优于对照组,差异有统计学意义(P<0.05);两组患者术后部分常见并发症(包括肺部感染、急性肾功能衰竭)及二次气管插管发生率比较,差异无统计学意义(P>0.05)。结论:三联预康复方案能改善老年心脏瓣膜置换手术患者围手术期的运动功能、营养状况及心理状态,可以为促进患者术后康复提供参考。Objective:To evaluate the effects of trimodal pre-rehabilitation program on older patients undergone cardiac valve replacement during perioperative period.Methods:From November 2021 to November 2022,forty older patients undergone cardiac valve replacement in cardiothoracic and vascular surgery department of a tertiary grade A hospital in Baise city were recruited by convenient sampling method,and were assigned to the control group and the pre-rehabilitation group according to the order of admission time,with 20 cases in each group.Patients in the control group were given routine care,and patients in the pre-rehabilitation group were given trimodal pre-rehabilitation program on the basis of routine care.At 24 hours after admission,1 day before surgery and 1 day before discharge,the 6-Minute Walking Test,serum prealbumin and serum albumin,anxiety and depression scores of two groups of patients were compared.The time of ventilator use,the time of activity out of bed,length of hospital stay,and some common postoperative complications(including pulmonary infection,acute renal failure)and secondary tractracular intubation incidence were compared between the two groups.Results:After the pre-rehabilitation,the results of 6-Minute Walking Test,serum prealbumin and serum albumin,anxiety and depression scores in the pre-rehabilitation group 1 day before operation and 1 day before discharge were significantly better than those in the control group(P<0.05).The time of ventilator use,the time of activity out of bed and length of hospital stay in the pre-rehabilitation group were significantly better than those in the control group 1 day before discharge(P<0.05).While the incidence of some common postoperative complications(including pulmonary infection,acute renal failure)and secondary tractracular intubation had no statistical significance(P>0.05).Conclusion:The trimodal pre-rehabilitation program can improve the motor function,nutritional status and psychological status of older patients with heart valve replacement surgery

关 键 词：心脏瓣膜置换 老年患者 三联预康复 围手术期 

分 类 号：R47[医药卫生—护理学] R197[医药卫生—临床医学]