精准化运动方案在心脏外科手术患者快速康复中的应用研究

目的：评价无创心输出量监测（ICG）指导下的精准化运动方案在心脏外科手术患者快速康复中的应用价值。方法：纳入2019年3月至2020年3月于中山大学附属第一医院心脏外科二区行心脏手术的80名患者，随机分为对照组和干预组，对照组40例，干预组40例，两组术前及术后（出院前）均进行无创血流动力学监测下的6分钟步行试验（6MWT），并签署知情同意书。对照组实施常规的运动康复措施，干预组通过6MWT过程中血流动力学的动态变化制定精准化的运动康复方案。比较2组患者的活动耐量、血流动力学指标、住院时间、术后下床时间、术后并发症等指标的差别。结果：1.干预组的活动耐量提高（6分钟步行试验距离（6MWD）430.48±54.62米VS 401.80±35.16米，P<0.05）、活动代谢当量（4.75±0.85 METS VS 4.03±0.54 METS,P<0.05）2.干预组的住院时间（29.57±7.24天VS 35.50±9.87 天，P<0.05）、术后下床时间（1.88±0.46天VS 2.15±0.43天，P<0.05）显著缩短。3.两组康复运动过程中的并发症：干预组患者在围术期实施康复运动过程中无发生并发症，对照组患者发生心律失常2例，其中房颤1例（2.5%），室性早搏1例（2.5%），呼吸困难2例（5%），气促2例（5%），血氧下降1例（2.5%）。结论：无创心输出量监测和6分钟步行试验联合指导下的精准化运动康复方案，可以大幅度地促进心脏外科手术患者的快速恢复。

Application of Precise Exercise Program in Rapid Rehabilitation

Objective: To evaluate the application value of precise exercise program guided by the Impedance Cardiography (ICG) in rapid rehabilitation of patients undergoing cardiac surgery. Method: 80 patients who underwent cardiac surgery at the First Affiliated Hospital of Sun Yat Sen University from March 2019 to March 2020 were randomly divided into control group and intervention group with 40 cases respectively. Both groups, who have signed the informed consent forms, were given a 6-minute walking test (6MWT) under non-invasive hemodynamics monitoring before and after surgery (before discharge). The Control Group received routine exercise rehabilitation measures, and the intervention group developed an accurate exercise rehabilitation program based on the dynamic changes of hemodynamics during the 6MWT process. The exercise capacity, hemodynamic indexes, hospitalization time, postoperative ambulation time and postoperative complications were compared between the two groups. Results: 1. The exercise capacity of intervention group was improved (6MWD: 430.48±54.6m vs 401.80 ±35.16m, P < 0.05), and so as the exercise metabolic equivalent (4.75±0.85 Mets vs 4.03±0.54 Mets, P < 0.05). 2. The hospitalization time (29.57±7.24 days vs 35.50±9.87days, P<0.05) and postoperative ambulation time (1.88±0.46 days vs 2.15±0.43 days, P < 0.05) were significantly shortened in the intervention group. 3. No complication was observed in the intervention group,but it can be observed in the control group,Arrhythmia occurred in 2 patients , including 1 case of atrial fibrillation (2.5%) and 1 case of ventricular premature beat (2.5%). In addition, there were 2 cases with dyspnea, 2 with shortness of breath (5%) , and 1 with hypoxemia (2.5%) .? Conclusion: The precise exercise rehabilitation program under the guidance of ICG and 6 MWT can significantly promote the rapid recovery of patients undergoing cardiac surgery.