吕钽,吴肖清.早期下床康复训练对心脏术后患者新发心房颤动的影响[J].中华物理医学与康复杂志,2025,47(5):419-424
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| 早期下床康复训练对心脏术后患者新发心房颤动的影响 |
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| DOI：10.3760/cma.j.cn421666-20240228-00150 |
| 中文关键词: 心脏术后 早期下床康复训练 术后新发心房颤动 回顾性研究 |
| 英文关键词: Cardiac surgery Ambulation rehabilitation training Atrial fibrillation Retrospective studies |
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| 中文摘要: |
| 目的 探讨早期下床康复训练对心脏术后患者新发心房颤动（NOAF）的影响，为优化心脏术后康复干预方案提供参考资料。 方法 本研究采用回顾性队列设计方案，将2023年1月至2024年3月期间在浙江大学医学院附属邵逸夫医院进行心脏手术治疗的364例患者作为观察对象，根据术后首次下床康复训练时间分为早期活动组（共114例，于术后24 h内下床进行康复训练）和对照组（共250例，于手术结束24 h后下床进行康复训练）。收集2组患者的一般资料、手术方式、NOAF发生情况等信息，采用COX比例风险回归模型分析早期下床康复训练与术后NOAF间的关联性。 结果 早期活动组术后住院期间的NOAF发生率（14.9%）较对照组（32.8%）明显降低（P<0.001）。多因素分析结果显示，心脏术后24 h内下床康复训练可能是NOAF发生的保护性因素［COX比例风险回归模型1：风险比（HR）=0.50，95%CI:0.29~0.84；模型2：HR=0.55，95%CI:0.32~0.95］。此外，早期活动组气管插管时间、主动脉阻断时间、监护室停留时间及总住院时间均较对照组明显缩短（P<0.05）。 结论 于术后24 h内开展下床康复训练可能对心脏术后患者NOAF发生具有一定保护和预防作用，有助于改善患者短期预后，但仍需进一步验证。 |
| 英文摘要: |
| Objective To explore any impact of early ambulation on new-onset atrial fibrillation (NOAF) after cardiac surgery. Methods This was a retrospective study covering 364 patients who had survived cardiac surgery. They were divided into an early-activity group (114 cases) whose rehabilitation began within 24 hours after their surgery and a control group (250 cases) whose rehabilitation training began later. Cox proportional hazards regression models were evaluated seeking evidence of any association between early ambulation and postoperative NOAF. Results The incidence of NOAF during hospitalization was significantly lower in the early-activity group (14.9%) compared to the control group (32.8%). Multivariate analysis revealed that ambulation within 24 hours after surgery may be a protective factor against NOAF. Additionally, the early-activity group exhibited shorter durations of endotracheal intubation and aortic cross-clamping, and tended to have shorter ICU and total hospitalization stays, on average. Conclusions Initiating ambulation within 24 hours after cardiac surgery predicts less risk of NOAF and improves short-term prognosis, suggesting a protective and preventive effect. However, further studies are needed to validate these findings. |
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